Provider Demographics
NPI:1366648420
Name:LANDUA-FIGUEROA, MARION M
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:M
Last Name:LANDUA-FIGUEROA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 SW PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-2628
Mailing Address - Country:US
Mailing Address - Phone:386-454-3502
Mailing Address - Fax:
Practice Address - Street 1:374 SW PRINCETON CT
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038-2628
Practice Address - Country:US
Practice Address - Phone:386-454-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033768400Medicaid