Healthcare Provider Details

I. General information

NPI: 1538839535
Provider Name (Legal Business Name): MS. JOSELYS LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SW 72ND ST
MIAMI FL
33173-5427
US

IV. Provider business mailing address

13267 NW 8TH TER
MIAMI FL
33182-1827
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-6448
  • Fax:
Mailing address:
  • Phone: 305-986-7330
  • 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: