Basic Information
| Provider Information | |||||||||
| NPI: | 1578145264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLO | ||||||||
| FirstName: | LIDIA | ||||||||
| MiddleName: | OFELIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1629 NW 14TH ST APT 911 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331252673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863934694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4020 W HILLSBORO BLVD | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334429416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2021 | ||||||||
| LastUpdateDate: | 09/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN1368 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.