Healthcare Provider Details

I. General information

NPI: 1609405208
Provider Name (Legal Business Name): RUDAYNA LANDERA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ALGARINGO AVE
CORAL GABLES FL
33134-6420
US

IV. Provider business mailing address

910 ALGARINGO AVE
CORAL GABLES FL
33134-6420
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-1969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6794
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86002430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: