Healthcare Provider Details

I. General information

NPI: 1306845599
Provider Name (Legal Business Name): LINA S PLANTILLA MD, FAAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 OCEAN AVE
BROOKLYN NY
11229-3916
US

IV. Provider business mailing address

2514 OCEAN AVE
BROOKLYN NY
11229-3916
US

V. Phone/Fax

Practice location:
  • Phone: 718-934-7373
  • Fax: 718-648-9548
Mailing address:
  • Phone: 718-934-7373
  • Fax: 718-648-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number74802680507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: