MEDICARE: ROBERTO A LLANTADA 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	208D00000X	General Practice Physician	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	:	1902890585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO A LLANTADA MD

Provider Business Mailing Address
First Line	:	3831 PALM AVE
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 AVE
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	05/11/2015

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