Healthcare Provider Details

I. General information

NPI: 1417482696
Provider Name (Legal Business Name): CLAUDIA ELISSA LANDAETA-GIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA ELISSA LANDAETA-GIMENEZ MD

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 SW 57TH AVE STE 110
SOUTH MIAMI FL
33143-3845
US

IV. Provider business mailing address

6620 SW 57TH AVE STE 110
SOUTH MIAMI FL
33143-3845
US

V. Phone/Fax

Practice location:
  • Phone: 305-845-9559
  • Fax: 305-468-6119
Mailing address:
  • Phone: 305-845-9559
  • Fax: 305-468-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME145230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: