Healthcare Provider Details

I. General information

NPI: 1902722176
Provider Name (Legal Business Name): LLANES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 DILLARD DR SE
PALM BAY FL
32909-2368
US

IV. Provider business mailing address

791 DILLARD DR SE
PALM BAY FL
32909-2368
US

V. Phone/Fax

Practice location:
  • Phone: 321-989-5378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: JORGE A MORALES
Title or Position: OWNER/OPERETOR
Credential:
Phone: 321-989-5378