Provider Demographics
NPI:1316686942
Name:LANDA MEDICAL CENTER CORP
Entity type:Organization
Organization Name:LANDA MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LANDA MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-443-1266
Mailing Address - Street 1:7400 W 20TH AVE APT 421
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1851
Mailing Address - Country:US
Mailing Address - Phone:786-443-1266
Mailing Address - Fax:844-866-4142
Practice Address - Street 1:7150 W 20TH AVE STE 402
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5532
Practice Address - Country:US
Practice Address - Phone:305-400-8600
Practice Address - Fax:844-866-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113412000Medicaid