Provider Demographics
NPI:1336694652
Name:LLESANA MEDICAL SPECIALIST CORP
Entity Type:Organization
Organization Name:LLESANA MEDICAL SPECIALIST CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-258-3698
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:14D
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:14D
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:305-305-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty