Healthcare Provider Details

I. General information

NPI: 1629328976
Provider Name (Legal Business Name): MILAGROS MARGARITA LLULL-VERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 SUNSET DR
SAN ANGELO TX
76901-5611
US

IV. Provider business mailing address

170 WILLIAM ST
NEW YORK NY
10038-2612
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberR3551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: