Healthcare Provider Details

I. General information

NPI: 1275113847
Provider Name (Legal Business Name): JAZIEL LLANES HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAZIEL LLANES MD

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 W CACTUS RD
GLENDALE AZ
85304-2245
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 602-842-4983
  • Fax:
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: