Healthcare Provider Details

I. General information

NPI: 1528520335
Provider Name (Legal Business Name): ALEXIS LOREN LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST STE 720
PEORIA IL
61602-5027
US

IV. Provider business mailing address

900 MAIN ST STE 720
PEORIA IL
61602-5027
US

V. Phone/Fax

Practice location:
  • Phone: 309-495-1640
  • Fax:
Mailing address:
  • Phone: 309-495-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.073986
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.158217
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.158217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: