Provider Demographics
NPI:1821130196
Name:FERNANDEZ-LLANIO, REGINA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIA
Last Name:FERNANDEZ-LLANIO
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 1:200 CRANDON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1567
Mailing Address - Country:US
Mailing Address - Phone:305-674-2599
Mailing Address - Fax:
Practice Address - Street 1:200 CRANDON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1567
Practice Address - Country:US
Practice Address - Phone:305-674-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264219100Medicaid
FLI22678Medicare UPIN
FL50704ZMedicare ID - Type Unspecified