Provider Demographics
NPI:1568520500
Name:GONZALEZ-LANDESTOY, MARIA MANUELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MANUELA
Last Name:GONZALEZ-LANDESTOY
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:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-1205
Mailing Address - Country:US
Mailing Address - Phone:480-275-4415
Mailing Address - Fax:480-275-4577
Practice Address - Street 1:2715 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE A-104
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-275-4415
Practice Address - Fax:480-275-4577
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29719207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0744170OtherBCBS
AZ0744170OtherBCBSAZ
AZ0744170OtherBCBSAZ
AZ632697Medicaid
AZH52196Medicare UPIN