Provider Demographics
NPI:1366285108
Name:ZULETA, ANDRES (CBHCM)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:ZULETA
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20131 CAROLINE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-0632
Mailing Address - Country:US
Mailing Address - Phone:954-939-4182
Mailing Address - Fax:
Practice Address - Street 1:20131 CAROLINE CREEK PL
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-0632
Practice Address - Country:US
Practice Address - Phone:954-939-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.010569171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator