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General NPI Number Information
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NPI Number | 1881789956
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Entity Type | Individual
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Provider Name | BEVERLY CAREN LAND DO
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3511 NW 91ST AVE
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City | DORAL
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State | FL
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Zip | 33172-1216
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Country | US
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Telephone | 305-437-1148
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Fax | 305-437-1064
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Provider Business Mailing Address
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Address Line | 3511 NW 91ST AVE
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City | DORAL
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State | FL
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Zip | 33172-1216
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Country | US
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Telephone | 305-437-1148
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Fax | 305-437-1064
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | J4284
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License Number State | TX
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