Basic Information
| Provider Information | |||||||||
| NPI: | 1235581315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLOSO | ||||||||
| FirstName: | ESTEFANI | ||||||||
| MiddleName: | NORMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4175 W 20TH AVE | ||||||||
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| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125874 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 4175 W 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058250300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP9431145 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | ARNP9431145 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.