Healthcare Provider Details

I. General information

NPI: 1548072960
Provider Name (Legal Business Name): DANNIS LLANO LABRADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE 30TH DR
HOMESTEAD FL
33033-5767
US

IV. Provider business mailing address

550 SE 30TH DR
HOMESTEAD FL
33033-5767
US

V. Phone/Fax

Practice location:
  • Phone: 305-786-1564
  • Fax:
Mailing address:
  • Phone: 305-786-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCBHCM.0107315-P
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: