Provider Demographics
NPI:1942735923
Name:ANDRES A DE LA LLANA MD INC
Entity Type:Organization
Organization Name:ANDRES A DE LA LLANA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES GAVINO
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:DE LA LLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-646-9010
Mailing Address - Street 1:15982 QUANTICO RD STE C
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1382
Mailing Address - Country:US
Mailing Address - Phone:760-646-9010
Mailing Address - Fax:760-810-0267
Practice Address - Street 1:15982 QUANTICO RD STE C
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1382
Practice Address - Country:US
Practice Address - Phone:760-646-9010
Practice Address - Fax:760-810-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54374261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40840Medicare UPIN