Healthcare Provider Details

I. General information

NPI: 1174732705
Provider Name (Legal Business Name): JOSE F LLACH JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 SW 136TH STREET
MIAMI FL
33186
US

IV. Provider business mailing address

13310 SW 101ST ST
MIAMI FL
33186-2815
US

V. Phone/Fax

Practice location:
  • Phone: 786-204-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberOS 10826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: