Healthcare Provider Details

I. General information

NPI: 1649412933
Provider Name (Legal Business Name): LLAVONA MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 65 INTANTERIA 76 SUR
LAJAS PR
00667
US

IV. Provider business mailing address

P.O. BOX 1717
LAJAS PR
00667-1717
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-5022
  • Fax: 787-899-5022
Mailing address:
  • Phone: 787-899-5022
  • Fax: 787-899-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ORLANDO J. LLAVONA
Title or Position: DOCTOR
Credential: M.D.
Phone: 787-899-5022