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General NPI Number Information
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NPI Number | 1326169095
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Entity Type | Individual
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Provider Name | MARIO F LANDERA ARNP
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 13400 SW 120TH ST STE 300A
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City | MIAMI
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State | FL
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Zip | 33186
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Country | US
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Telephone | 305-221-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 15032 SW 65TH TER
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City | MIAMI
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State | FL
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Zip | 33193-2009
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Country | US
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Telephone | 305-246-6846
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Fax | 305-246-6963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1232072
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License Number State | FL
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