1144776394 NPI number — MRS. CHRISTINA MARIE LANDON B.C.B.A

Table of content: MRS. CHRISTINA MARIE LANDON B.C.B.A (NPI 1144776394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144776394 NPI number — MRS. CHRISTINA MARIE LANDON B.C.B.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDON
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.C.B.A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144776394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4221 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 300A
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-866-1880
Provider Business Mailing Address Fax Number:
323-866-1881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7750 COLLEGE TOWN DR STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95826-2362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-866-1880
Provider Business Practice Location Address Fax Number:
323-866-1881
Provider Enumeration Date:
08/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-16-22570 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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