Provider Demographics
NPI:1841022092
Name:ESCANIO LLERENA, ALBERTO
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:ESCANIO LLERENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LIVE OAK AVE W APT 6106
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5092
Mailing Address - Country:US
Mailing Address - Phone:863-399-3654
Mailing Address - Fax:
Practice Address - Street 1:575 LIVE OAK AVE W APT 6106
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5092
Practice Address - Country:US
Practice Address - Phone:863-399-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE254-000-72-163-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver