Healthcare Provider Details

I. General information

NPI: 1598532202
Provider Name (Legal Business Name): DR. DIEGO ANDRES LLANES ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5597 N DIXIE HWY
OAKLAND PARK FL
33334-3406
US

IV. Provider business mailing address

8215 SW 72ND AVE APT 1816
MIAMI FL
33143-7877
US

V. Phone/Fax

Practice location:
  • Phone: 954-267-6390
  • Fax: 954-276-6398
Mailing address:
  • Phone: 954-707-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: