Healthcare Provider Details

I. General information

NPI: 1073929139
Provider Name (Legal Business Name): MONICA LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAWGRASS CORPORATE PKWY SUITE 106
SUNRISE FL
33325-6244
US

IV. Provider business mailing address

440 SAWGRASS CORPORATE PKWY SUITE 106
SUNRISE FL
33325-6244
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-1112
  • Fax:
Mailing address:
  • Phone: 954-745-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: