Provider Demographics
NPI:1548247299
Name:LLERENA, VILMA VIRGILIA (MD)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:VIRGILIA
Last Name:LLERENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16525 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2532
Mailing Address - Country:US
Mailing Address - Phone:787-286-1845
Mailing Address - Fax:
Practice Address - Street 1:4800 W FLAGLER ST STE 215
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:954-368-4786
Practice Address - Fax:954-368-4101
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN677207Q00000X, 207RE0101X
PR14663208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3519OtherPREFERRED MEDICARE CHOICE
100104OtherCRUZ AZUL DE PUERTO RICO
9560000OtherHUMANA INS
21394LLOtherMEDICARE OPTIMO
3478OtherAMERICAN HEALTH INC
2011271OtherPREFERRED HEALTH
21394LLOtherTRIPLE S
500157SEOtherMEDICARE Y MUCHO MAS
PG4474OtherPALIC
21394LLOtherMEDICARE OPTIMO
PR21394Medicare ID - Type Unspecified