1548247299 NPI number — VILMA VIRGILIA LLERENA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548247299 NPI number — VILMA VIRGILIA LLERENA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LLERENA

Provider First Name:

VILMA

Provider Middle Name:

VIRGILIA

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1548247299

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/08/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

16525 OLD CUTLER RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PALMETTO BAY

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33157-2532

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-286-1845

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

4800 W FLAGLER ST STE 215

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CORAL GABLES

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33134

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

954-368-4786

Provider Business Practice Location Address Fax Number:

954-368-4101

Provider Enumeration Date:

12/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  ACN677 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208D00000X , with the licence number: 14663 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RE0101X , with the licence number: ACN677 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3519 . This is a "PREFERRED MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 100104 . This is a "CRUZ AZUL DE PUERTO RICO" identifier . This identifiers is of the category "OTHER".
• Identifier: 9560000 . This is a "HUMANA INS" identifier . This identifiers is of the category "OTHER".
• Identifier: 21394LL . This is a "MEDICARE OPTIMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 3478 . This is a "AMERICAN HEALTH INC" identifier . This identifiers is of the category "OTHER".
• Identifier: 2011271 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 21394LL . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
• Identifier: 500157SE . This is a "MEDICARE Y MUCHO MAS" identifier . This identifiers is of the category "OTHER".
• Identifier: PG4474 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 114887100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".