Provider Demographics
NPI:1639182348
Name:LANDMAN, ALIX B (MPH RD CDCES)
Entity Type:Individual
Prefix:MS
First Name:ALIX
Middle Name:B
Last Name:LANDMAN
Suffix:
Gender:F
Credentials:MPH RD CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1549
Mailing Address - Country:US
Mailing Address - Phone:954-792-7303
Mailing Address - Fax:954-792-7656
Practice Address - Street 1:7901 SW 6TH CT STE 320
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3283
Practice Address - Country:US
Practice Address - Phone:954-792-7303
Practice Address - Fax:954-792-7656
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1628133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0110Medicare UPIN