Healthcare Provider Details

I. General information

NPI: 1053258681
Provider Name (Legal Business Name): DRUG ENFORCEMENT ADMINISTRATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 EAST IRLO BROSON HWY 180
APO AA
34747
US

IV. Provider business mailing address

2295 EAST IRLO BROSON HWY 180
APO AA
34747
US

V. Phone/Fax

Practice location:
  • Phone: 305-609-0024
  • Fax:
Mailing address:
  • Phone: 305-609-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIO J LANDAETA
Title or Position: SAC
Credential: PSYD
Phone: 305-609-0024