Provider Demographics
NPI:1902427628
Name:LANDA, LIANNE
Entity Type:Individual
Prefix:MRS
First Name:LIANNE
Middle Name:
Last Name:LANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 FONTAINEBLEAU BLVD APT E217
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5692
Mailing Address - Country:US
Mailing Address - Phone:732-791-8668
Mailing Address - Fax:
Practice Address - Street 1:10520 NW 26TH ST STE C201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2161
Practice Address - Country:US
Practice Address - Phone:305-364-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator