MEDICARE: ROBERTO A LLANTADA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME28478	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245478965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO A LLANTADA MD PA

Provider Business Mailing Address
First Line	:	3831 PALM AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4445
Country	:	US
Telephone Number	:	305-557-0092
Fax Number	:	305-557-0450

Provider Business Practice Location Address
First Line	:	3831 PALM AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4445
Country	:	US
Telephone Number	:	305-557-0092
Fax Number	:	305-557-0450

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. ROBERTO A LLANTADA
Credential	:	MD
Telephone Number	:	305-557-0092

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	05/04/2009

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