Healthcare Provider Details

I. General information

NPI: 1265713739
Provider Name (Legal Business Name): MS. ELAINE LLANIO-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 FORUM PL # 400D&E
WEST PALM BEACH FL
33401-2319
US

IV. Provider business mailing address

8126 S LAKE DR
WEST PALM BEACH FL
33406-7828
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-8411
  • Fax:
Mailing address:
  • Phone: 561-540-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: