Healthcare Provider Details

I. General information

NPI: 1265415939
Provider Name (Legal Business Name): LUIS PLASENCIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2005
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SW 87TH AVE # 3C
MIAMI FL
33174-3253
US

IV. Provider business mailing address

8741 CORAL WAY
MIAMI FL
33165-2005
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-0109
  • Fax: 305-551-2953
Mailing address:
  • Phone: 305-226-7800
  • Fax: 305-551-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 45681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: