MEDICARE: ANNABELLA CAFE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174200000X	Meals Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063035061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNABELLA CAFE CORP

Provider Business Mailing Address
First Line	:	600 W 27TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1214
Country	:	US
Telephone Number	:	786-537-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W 27TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1214
Country	:	US
Telephone Number	:	786-537-5383
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ULISES FERNANDEZ
Credential	:
Telephone Number	:	786-537-5383

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	05/26/2020

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Directions to “ANNABELLA CAFE CORP ” Practice Location

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