MEDICARE: DR. JAZIEL LLANES HERNANDEZ MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	74440	AZ

General Provider Information

NPI Number	:	1275113847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAZIEL LLANES HERNANDEZ MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 W CACTUS RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2245
Country	:	US
Telephone Number	:	602-842-4983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	02/14/2025

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