Healthcare Provider Details

I. General information

NPI: 1902093263
Provider Name (Legal Business Name): CARMEN ELENA LANDAVERDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CAMDEN ST STE 108
SAN ANTONIO TX
78215-2100
US

IV. Provider business mailing address

1111 W 34TH ST SUITE 210
AUSTIN TX
78705-1900
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax: 210-227-6951
Mailing address:
  • Phone: 512-454-8378
  • Fax: 512-454-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN5797
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberN5797
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberN5797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: