Provider Demographics
NPI:1013444603
Name:ALLERGY AND IMMUNOLOGY CARE CENTER OF SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:ALLERGY AND IMMUNOLOGY CARE CENTER OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-646-9280
Mailing Address - Street 1:16371 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6044
Mailing Address - Country:US
Mailing Address - Phone:786-646-9280
Mailing Address - Fax:
Practice Address - Street 1:16371 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6044
Practice Address - Country:US
Practice Address - Phone:786-646-9280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty