Provider Demographics
NPI:1588954077
Name:PUEBLA LLANOS, DANAY (LMT)
Entity type:Individual
Prefix:
First Name:DANAY
Middle Name:
Last Name:PUEBLA LLANOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15387 SW 15TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2671
Mailing Address - Country:US
Mailing Address - Phone:305-338-6436
Mailing Address - Fax:888-554-7594
Practice Address - Street 1:15387 SW 15TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2671
Practice Address - Country:US
Practice Address - Phone:305-338-6436
Practice Address - Fax:888-554-7594
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61527175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA61527OtherLMT