Organization
MMGL, LLC
Active
Other names
FIVE STAR MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA MANUELA GONZALEZ-LANDESTOY MD (OWNER/PHYSICIAN)
(480) 275-4415
Entity
Organization
Contact information
Practice address
2175 N. ALMA SCHOOL RD., SUITE A- 104, CHANDLER, AZ 85224
(480) 275-4415
(480) 275-4577
Mailing address
2175 N. ALMA SCHOOL RD., SUITE A- 104, CHANDLER, AZ 85224
(480) 275-4415
(480) 275-4577
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
29719
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0744170
AZ BC/BS
AZ
05
—
632697
—
AZ
01
—
Z78260
MEDICARE GROUP NUMBER
AZ
Enumeration date
02/22/2008
Last updated
02/19/2020
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