Healthcare Provider Details

I. General information

NPI: 1275326514
Provider Name (Legal Business Name): KENIA PRIETO LARREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16875 NW 2ND AVE SUITE 208
NORTH MIAMI FL
33169
US

IV. Provider business mailing address

19702 NW 32ND PL
MIAMI GARDENS FL
33056-2316
US

V. Phone/Fax

Practice location:
  • Phone: 786-707-0966
  • Fax:
Mailing address:
  • Phone: 786-707-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: