Provider Demographics
NPI:1659340875
Name:LLAVONA GONZALEZ, ORLANDO J (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:J
Last Name:LLAVONA GONZALEZ
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:CALLE 65 INFANTERIA 76 SUR
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-5022
Mailing Address - Fax:787-899-5022
Practice Address - Street 1:CALLE 65 INFANTERIA 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
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20626Medicare UPIN
22768Medicare ID - Type Unspecified