Provider Demographics
NPI:1649412933
Name:LLAVONA MEDICAL SERVICES
Entity Type:Organization
Organization Name:LLAVONA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LLAVONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-899-5022
Mailing Address - Street 1:P.O. BOX 1717
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1717
Mailing Address - Country:US
Mailing Address - Phone:787-899-5022
Mailing Address - Fax:787-899-5022
Practice Address - Street 1:CALLE 65 INTANTERIA 76 SUR
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-5022
Practice Address - Fax:787-899-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI20626Medicare UPIN
PR0022768Medicare PIN