Provider Demographics
NPI:1255778320
Name:JOSE F LANDA M.D., P.A.
Entity type:Organization
Organization Name:JOSE F LANDA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:LANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-1411
Mailing Address - Street 1:620 SW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1912
Mailing Address - Country:US
Mailing Address - Phone:305-444-1411
Mailing Address - Fax:305-448-4558
Practice Address - Street 1:620 SW 42ND AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1912
Practice Address - Country:US
Practice Address - Phone:305-444-1411
Practice Address - Fax:305-448-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71458OtherMEDICARE PROVIDER
FLD58079Medicare UPIN