DR. MATT SPENCER LALLAS (NPI# 1700170180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700170180 |
| Entity Type | Individual |
| Full Name | DR. MATT SPENCER LALLAS |
| Credential | M.D. |
| Practice Address |
3200 Sw 60th Ct Ste 302 Miami FL 33155-4071 |
| Practice Telephone | 9543710107 |
| Mailing Telephone | 3056628330 |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2020-06-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
ME118674 | FL | Allopathic & Osteopathic Physicians |
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
A116424 | CA | Allopathic & Osteopathic Physicians |
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
A116424 | CA | Allopathic & Osteopathic Physicians |
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
ME118674 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 014784900 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3200 Sw 60th Ct Ste 302, Miami, FL 331554071 | 9543710107 |
| Street Address |
3200 SW 60TH CT STE 302 |
| City | MIAMI |
| State | FL |
| Zip Code | 33155-4071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619934338 | Michael S Duchowny | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155 | 2006-04-27 |
| 1851858021 | Dayami Porto Fajardo | Nurse Practitioner | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2019-02-25 |
| 1255809737 | Gisselle Maria Fraga | Nurse Practitioner | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2018-11-02 |
| 1871020073 | Leah Nicole Medina | Nurse Practitioner | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2017-05-18 |
| 1558809087 | Patricia Correa | Nurse Practitioner | 3200 Sw 60th Ct Ste 302, Ste 302, Miami, FL 33155-4071 | 2017-02-03 |
| 1609125905 | Anuj Jayakar | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2012-08-31 |
| 1083973572 | Marytery Fajardo | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2012-05-03 |
| 1275832032 | Natanya Maio Mishal | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155 | 2011-03-19 |
| 1184949182 | Migvis Monduy | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155 | 2010-04-01 |
| 1679809180 | Vicente Manuel Martinez Cardenas | Nurse Practitioner | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2009-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659987121 | Blanca Argentina Torres | Speech-Language Pathologist | 6840 Bird Rd Unit 211a, Miami, FL 33155 | 2020-09-21 |
| 1245888585 | Mila De La Caridad Broche Coego | Behavior Technician | 2247 Sw 68th Ct, Miami, FL 33155 | 2019-08-29 |
| 1265087878 | Nancy Acela Denis | Nurse Practitioner | 6791 Sw 25 Terra, Miami, FL 33155 | 2019-08-09 |
| 1700366887 | Aly Hashim | Family Medicine | 2805 Sw 75th Avenue, Miami, FL 33155 | 2018-08-17 |
| 1184115362 | Ready 2 Transfer, Inc. | Non-emergency Medical Transport (VAN) | 7811 Sw 24 Street #120, Miami, FL 33155 | 2018-05-23 |
| 1053808030 | Idalmis Pimentel Diez | Behavior Technician | 6334 Sw 30th St, Miami, FL 33155 | 2018-04-16 |
| 1225538689 | L & L Social Services LLC | Case Management | 5950 Sw 40 St, Miami, FL 33155 | 2018-02-12 |
| 1659888915 | Red Bird Dental Care | Dentist | 5771 Sw 40 St, Miami, FL 33155 | 2018-01-08 |
| 1043726474 | Jesenia Rodriguez-vila | Nurse Practitioner | 6433 Sw 29th St, Miami, FL 33155 | 2017-12-21 |
| 1326553736 | Believe Neuro-behavioral Services | Behavioral Analyst | 6700 Sw 38th St, Miami, FL 33155 | 2017-12-07 |
| Find all providers in zip 33155 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942557863 | Henry Osso-rivera | Psychiatry & Neurology | 3100 Sw 62nd Ave Ofc, Miami, FL 33155-3009 | 2012-08-09 |
| 1972698108 | Israel Alfonso | Psychiatry & Neurology | 3200 Sw 60 Ct, Suite #302, Miami, FL 33155 | 2006-10-04 |
| 1427143619 | Elza Vasconcellos | Psychiatry & Neurology | 3850 Bird Rd Ste 701, Miami, FL 33146-1507 | 2006-10-04 |
| 1053849927 | Robert F. Cullen, Jr., Md., Pa | Psychiatry & Neurology | 15715 S Dixie Hwy Ste 407, Miami, FL 33157 | 2017-05-23 |
| 1336693274 | Pediatric Specialty Group, Inc. | Psychiatry & Neurology | 3100 Sw 62nd Ave, Suite 302, Miami, FL 33155-3009 | 2016-08-09 |
| 1609125905 | Anuj Jayakar | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2012-08-31 |
| 1083973572 | Marytery Fajardo | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155-4071 | 2012-05-03 |
| 1275832032 | Natanya Maio Mishal | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155 | 2011-03-19 |
| 1184949182 | Migvis Monduy | Psychiatry & Neurology | 3200 Sw 60th Ct Ste 302, Miami, FL 33155 | 2010-04-01 |
| 1912133539 | Alyssa D Pensirikul | Psychiatry & Neurology | 1150 Nw 14th St, Miami, FL 33136-2137 | 2009-06-10 |
| Find all providers in MIAMI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.