Healthcare Provider Details

I. General information

NPI: 1760172811
Provider Name (Legal Business Name): JULIO A LLAMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S LE JEUNE RD
CORAL GABLES FL
33134-5809
US

IV. Provider business mailing address

7655 SW 138TH ST
PALMETTO BAY FL
33158-1280
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-2222
  • Fax:
Mailing address:
  • Phone: 786-290-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9403966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: