MEDICARE: ANNABELLY LUIS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1346768611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNABELLY LUIS

Provider Business Mailing Address
First Line	:	4834 NW 167TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6426
Country	:	US
Telephone Number	:	239-321-1002
Fax Number	:	305-625-6236

Provider Business Practice Location Address
First Line	:	4834 NW 167TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6426
Country	:	US
Telephone Number	:	239-321-1002
Fax Number	:	305-625-6236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	07/21/2022

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Directions to “ ANNABELLY LUIS ” Practice Location

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