Provider Demographics
NPI:1487667994
Name:LLERENA, SARA N (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:N
Last Name:LLERENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 SW 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2202
Mailing Address - Country:US
Mailing Address - Phone:305-541-5090
Mailing Address - Fax:305-541-2221
Practice Address - Street 1:1451 SW 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2202
Practice Address - Country:US
Practice Address - Phone:305-541-5090
Practice Address - Fax:305-541-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0056413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61990Medicare UPIN
FL08277Medicare ID - Type Unspecified