Provider Demographics
NPI:1962022152
Name:LALLAVE - CORTES, LYNNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:LALLAVE - CORTES
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 1:931 W OAK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4973
Mailing Address - Country:US
Mailing Address - Phone:407-931-0444
Mailing Address - Fax:407-962-4446
Practice Address - Street 1:900 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3470
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-962-4446
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21878208D00000X
FLACN1425208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice