Healthcare Provider Details

I. General information

NPI: 1154012326
Provider Name (Legal Business Name): ROBERTO LLAVINA CBHCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

IV. Provider business mailing address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-9079
  • Fax: 407-964-1274
Mailing address:
  • Phone: 407-382-9079
  • Fax: 407-964-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCM.0105934-P
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: