Healthcare Provider Details
I. General information
NPI: 1013962158
Provider Name (Legal Business Name): JOSEPH LLINAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/24/2006
Last Update Date: 08/03/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
465 MINUTEMEN CSWY UNIT 485
COCOA BEACH FL
32931-2828
US
IV. Provider business mailing address
485 MINUTEMEN CSWY
COCOA BEACH FL
32931
US
V. Phone/Fax
- Phone: 321-613-5595
- Fax: 321-613-8477
- Phone: 321-613-5595
- Fax: 321-613-8477
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | ME116732 |
| License Number State | FL |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 593VF |
| Identifier Type | OTHER |
| Identifier State | FL |
| Identifier Issuer | BCBS |
| # 2 | |
| Identifier | 009418700 |
| Identifier Type | MEDICAID |
| Identifier State | FL |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: