Healthcare Provider Details

I. General information

NPI: 1912777343
Provider Name (Legal Business Name): ORQUIDEA IREISDEL LLAMOSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 57TH AVE STE 114
MIAMI FL
33126-2041
US

IV. Provider business mailing address

501 SW 90TH CT
MIAMI FL
33174-2343
US

V. Phone/Fax

Practice location:
  • Phone: 786-337-1451
  • Fax: 305-513-5739
Mailing address:
  • Phone: 786-893-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23314388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: