Healthcare Provider Details

I. General information

NPI: 1003163494
Provider Name (Legal Business Name): ROXANA MARIE LLANES SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 SW 137TH AVE
MIAMI FL
33175-6462
US

IV. Provider business mailing address

14291 SW 120TH ST STE 103
MIAMI FL
33186-7287
US

V. Phone/Fax

Practice location:
  • Phone: 305-385-0168
  • Fax: 305-385-0182
Mailing address:
  • Phone: 305-385-0168
  • Fax: 305-385-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: