Provider Demographics
NPI:1659841203
Name:LAND AUDIOLOGY PLLC
Entity type:Organization
Organization Name:LAND AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MICHELLE MENDEZ
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:512-925-0965
Mailing Address - Street 1:7509 MENCHACA RD UNIT 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6055
Mailing Address - Country:US
Mailing Address - Phone:512-829-8690
Mailing Address - Fax:512-661-2056
Practice Address - Street 1:7509 MENCHACA RD UNIT 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6055
Practice Address - Country:US
Practice Address - Phone:512-829-8690
Practice Address - Fax:512-661-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80796OtherSTATE LICENSE