Provider Demographics
NPI:1205096898
Name:PEDRO P LLANEZA MD PA
Entity type:Organization
Organization Name:PEDRO P LLANEZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:P
Authorized Official - Last Name:LLANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-9090
Mailing Address - Street 1:9195 SW 72ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3488
Mailing Address - Country:US
Mailing Address - Phone:305-598-9090
Mailing Address - Fax:305-598-0668
Practice Address - Street 1:9195 SW 72ND ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3488
Practice Address - Country:US
Practice Address - Phone:305-598-9090
Practice Address - Fax:305-598-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL526Medicare PIN