Healthcare Provider Details

I. General information

NPI: 1588954077
Provider Name (Legal Business Name): DANAY PUEBLA LLANOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15387 SW 15TH LN
MIAMI FL
33194-2671
US

IV. Provider business mailing address

15387 SW 15TH LN
MIAMI FL
33194-2671
US

V. Phone/Fax

Practice location:
  • Phone: 305-338-6436
  • Fax: 888-554-7594
Mailing address:
  • Phone: 305-338-6436
  • Fax: 888-554-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberMA61527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: