Healthcare Provider Details

I. General information

NPI: 1891707352
Provider Name (Legal Business Name): BERNARDITA LLURBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1757 W 72ND ST
HIALEAH FL
33014-4465
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5768
  • Fax:
Mailing address:
  • Phone: 954-436-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1019762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: