Healthcare Provider Details

I. General information

NPI: 1174812564
Provider Name (Legal Business Name): ANGEL ENRIQUE LLANIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 4TH AVE W
PALMETTO FL
34221-5226
US

IV. Provider business mailing address

367 S. GULPH RD ATT: IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 941-722-7785
  • Fax: 941-729-5267
Mailing address:
  • Phone: 775-356-9393
  • Fax: 775-356-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS11980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: