Provider Demographics
NPI:1841575875
Name:LLERENA, ANA MARIA G
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:G
Last Name:LLERENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SUNNY PINE WAY
Mailing Address - Street 2:B-1
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8968
Mailing Address - Country:US
Mailing Address - Phone:561-392-3341
Mailing Address - Fax:561-829-5482
Practice Address - Street 1:4383 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6253
Practice Address - Country:US
Practice Address - Phone:561-392-3341
Practice Address - Fax:561-829-5482
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist