Provider Demographics
NPI:1376785980
Name:JENNIFER LANDA, LLC OF FLORIDA
Entity Type:Organization
Organization Name:JENNIFER LANDA, LLC OF FLORIDA
Other - Org Name:BODYLOGICMD OF ORLANDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-799-5821
Mailing Address - Street 1:3039 CECELIA DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7813
Mailing Address - Country:US
Mailing Address - Phone:888-799-5821
Mailing Address - Fax:866-402-5245
Practice Address - Street 1:175 LOOKOUT PL
Practice Address - Street 2:SUITE 201
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8434
Practice Address - Country:US
Practice Address - Phone:888-799-5821
Practice Address - Fax:866-402-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty