Healthcare Provider Details

I. General information

NPI: 1699404400
Provider Name (Legal Business Name): RAQUEL LINEVSKY TILLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD STE 1190
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

785 WEYBURN TER APT C18
LOS ANGELES CA
90024-2895
US

V. Phone/Fax

Practice location:
  • Phone: 954-465-5529
  • Fax:
Mailing address:
  • Phone: 954-465-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: