Healthcare Provider Details

I. General information

NPI: 1811365836
Provider Name (Legal Business Name): SUSANA LANDAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANA CALDERON MORENO

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 COFFEE RD STE 140
BAKERSFIELD CA
93308-5044
US

IV. Provider business mailing address

4015 COFFEE RD STE 140
BAKERSFIELD CA
93308-5044
US

V. Phone/Fax

Practice location:
  • Phone: 661-484-0079
  • Fax: 661-564-8546
Mailing address:
  • Phone: 661-484-0079
  • Fax: 661-564-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT114302
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF94367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: