Provider Demographics
NPI:1417482696
Name:LANDAETA MEDINA, CLAUDIA ELISSA (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ELISSA
Last Name:LANDAETA MEDINA
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:305-532-3378
Mailing Address - Fax:305-532-1164
Practice Address - Street 1:4308 ALTON RD STE 910
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4560
Practice Address - Country:US
Practice Address - Phone:305-532-3378
Practice Address - Fax:305-532-1164
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108290300Medicaid