Healthcare Provider Details

I. General information

NPI: 1326544552
Provider Name (Legal Business Name): MARIA LLANOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 SW 57TH AVE STE 21
SOUTH MIAMI FL
33143-5546
US

IV. Provider business mailing address

7900 SW 57TH AVE STE 21
SOUTH MIAMI FL
33143-5546
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-3984
  • Fax: 305-661-1129
Mailing address:
  • Phone: 305-662-3984
  • Fax: 305-661-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS19845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: