1558368787 NPI number — DR. ALFONSO LLANO M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558368787 NPI number — DR. ALFONSO LLANO M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LLANO

Provider First Name:

ALFONSO

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1558368787

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/14/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 43130

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TUCSON

Provider Business Mailing Address State Name:

AZ

Provider Business Mailing Address Postal Code:

85733-3130

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

520-722-3777

Provider Business Mailing Address Fax Number:

520-296-6224

Provider First Line Business Practice Location Address:

7383 E TANQUE VERDE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TUCSON

Provider Business Practice Location Address State Name:

AZ

Provider Business Practice Location Address Postal Code:

85715-3475

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

520-318-3434

Provider Business Practice Location Address Fax Number:

520-296-6224

Provider Enumeration Date:

07/01/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  0101223311 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 41384 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 219970 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 541910047 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 298373 . This is a "MDIPA/MAMSI/OPTIMUM" identifier . This identifiers is of the category "OTHER".
• Identifier: 541910047 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 603296 . This is a "BC/BS PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 110231194 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 8906415 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 911940000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 005863571 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 51574 . This is a "SENTARA OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".