Healthcare Provider Details

I. General information

NPI: 1063220531
Provider Name (Legal Business Name): LYN LLUMBET
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SW 16TH ST
MIAMI FL
33145-2026
US

IV. Provider business mailing address

3636 SW 9TH ST
MIAMI FL
33135-4284
US

V. Phone/Fax

Practice location:
  • Phone: 305-910-7754
  • Fax:
Mailing address:
  • Phone: 786-301-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: