=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124216320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANDA-GALINDEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2007
-----------------------------------------------------
Last Update Date | 12/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 SW 57TH AVE SUITE 300
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-668-5103
-----------------------------------------------------
Fax | 305-668-5125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7600 SW 57TH AVE SUITE 300
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-668-5103
-----------------------------------------------------
Fax | 305-668-5125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMALIA MERCEDES LANDA-GALINDEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-668-5103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0069836
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------