Provider Demographics
NPI:1245478965
Name:ROBERTO A LLANTADA MD PA
Entity type:Organization
Organization Name:ROBERTO A LLANTADA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLANTADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-557-0092
Mailing Address - Street 1:3831 PALM AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4445
Mailing Address - Country:US
Mailing Address - Phone:305-557-0092
Mailing Address - Fax:305-557-0450
Practice Address - Street 1:3831 PALM AVENUE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4445
Practice Address - Country:US
Practice Address - Phone:305-557-0092
Practice Address - Fax:305-557-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28478261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92345Medicare UPIN