Healthcare Provider Details

I. General information

NPI: 1952172595
Provider Name (Legal Business Name): VIVIAN ZINET LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 SW 28TH ST
CAPE CORAL FL
33914-8211
US

IV. Provider business mailing address

1528 SW 28TH ST
CAPE CORAL FL
33914-8211
US

V. Phone/Fax

Practice location:
  • Phone: 786-273-1158
  • Fax:
Mailing address:
  • Phone: 786-273-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-309231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: