Healthcare Provider Details

I. General information

NPI: 1861212052
Provider Name (Legal Business Name): ODET LLANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20340 SW 118TH PL
MIAMI FL
33177-5436
US

IV. Provider business mailing address

20340 SW 118TH PL
MIAMI FL
33177-5436
US

V. Phone/Fax

Practice location:
  • Phone: 786-870-3210
  • Fax:
Mailing address:
  • Phone: 786-870-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-148074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: