Provider Demographics
NPI:1972156602
Name:BITTAN DE BELLANDE, FORTUNA (AP)
Entity type:Individual
Prefix:
First Name:FORTUNA
Middle Name:
Last Name:BITTAN DE BELLANDE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:FORTUNA
Other - Middle Name:
Other - Last Name:BELLANDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:12357 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5428
Mailing Address - Country:US
Mailing Address - Phone:713-449-5504
Mailing Address - Fax:
Practice Address - Street 1:1210 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1527
Practice Address - Country:US
Practice Address - Phone:713-449-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist