Provider Demographics
NPI:1093445231
Name:LLANOS, KEVIN DONNELL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DONNELL
Last Name:LLANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 STEED CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2843
Mailing Address - Country:US
Mailing Address - Phone:757-292-5096
Mailing Address - Fax:
Practice Address - Street 1:2905 STEED CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2843
Practice Address - Country:US
Practice Address - Phone:757-292-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2200665172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver