Provider Demographics
NPI:1750154548
Name:BRILLIANT FUTURE LLC
Entity type:Organization
Organization Name:BRILLIANT FUTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-346-9383
Mailing Address - Street 1:1365 W 28TH ST APT 3NA
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1036
Mailing Address - Country:US
Mailing Address - Phone:178-634-6938
Mailing Address - Fax:
Practice Address - Street 1:1365 W 28TH ST APT 3NA
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1036
Practice Address - Country:US
Practice Address - Phone:178-634-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty