Provider Demographics
NPI:1619138021
Name:LAUREN, BELLA (DOM)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:LAUREN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S US HIGHWAY 1 STE 1
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2740
Mailing Address - Country:US
Mailing Address - Phone:561-762-4273
Mailing Address - Fax:
Practice Address - Street 1:17951 133RD TRL N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-4686
Practice Address - Country:US
Practice Address - Phone:561-596-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW121176B00000X
FLAP2943171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340278900Medicaid