Provider Demographics
NPI:1578308003
Name:LLANO, ADONIS ISRAEL
Entity type:Individual
Prefix:
First Name:ADONIS
Middle Name:ISRAEL
Last Name:LLANO
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 1:28 TRIDENT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1364
Mailing Address - Country:US
Mailing Address - Phone:774-301-9336
Mailing Address - Fax:
Practice Address - Street 1:28 TRIDENT AVE APT 2
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1364
Practice Address - Country:US
Practice Address - Phone:774-301-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty