Healthcare Provider Details

I. General information

NPI: 1922097815
Provider Name (Legal Business Name): HUGO LLANES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 SW 107TH AVE
MIAMI FL
33174-2515
US

IV. Provider business mailing address

1303 SW 107TH AVE
MIAMI FL
33174-2515
US

V. Phone/Fax

Practice location:
  • Phone: 305-322-4648
  • Fax: 305-262-6099
Mailing address:
  • Phone: 305-322-4648
  • Fax: 305-262-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0068077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: