Healthcare Provider Details

I. General information

NPI: 1457116493
Provider Name (Legal Business Name): VICTORIA LLANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 VIDA CIR UNIT 105
BRADENTON FL
34211-2863
US

IV. Provider business mailing address

11160 VIDA CIR UNIT 105
BRADENTON FL
34211-2863
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-9844
  • Fax:
Mailing address:
  • Phone: 786-252-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: