MEDICARE: ROBERTO LLANTADA ,MD,PA

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	207R00000X	Internal Medicine Physician	0028478	FL

General Provider Information

NPI Number	:	1265566160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO LLANTADA ,MD,PA

Provider Business Mailing Address
First Line	:	3831 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4445
Country	:	US
Telephone Number	:	305-557-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4445
Country	:	US
Telephone Number	:	305-557-0092
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERTO LLANTADA
Credential	:	MD
Telephone Number	:	305-557-0092

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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