Healthcare Provider Details

I. General information

NPI: 1265955900
Provider Name (Legal Business Name): PENELOPE LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 SW 42ND ST STE 219
MIAMI FL
33175-2933
US

IV. Provider business mailing address

12905 SW 42ND ST STE 219
MIAMI FL
33175-2933
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-5702
  • Fax:
Mailing address:
  • Phone: 786-536-5702
  • 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: