Provider Demographics
NPI:1659305589
Name:LLANSO, RAFAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:LLANSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SAN LORENZO AVE.
Mailing Address - Street 2:SUITE 3230
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1448
Mailing Address - Country:US
Mailing Address - Phone:305-444-6882
Mailing Address - Fax:308-441-9110
Practice Address - Street 1:358 SAN LORENZO AVE.
Practice Address - Street 2:SUITE 3230
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1448
Practice Address - Country:US
Practice Address - Phone:305-444-6882
Practice Address - Fax:308-441-9110
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74544Medicare UPIN