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General NPI Number Information
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NPI Number | 1063720852
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Entity Type | Individual
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Provider Name | LYNETTE LEANOR LLINAS R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 11307 SW OLMSTEAD DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1947
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Country | US
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Telephone | 772-345-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 11307 SW OLMSTEAD DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1947
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Country | US
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Telephone | 772-345-0577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DEH 18811
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License Number State | FL
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