Healthcare Provider Details

I. General information

NPI: 1982972998
Provider Name (Legal Business Name): MICHELLE LANDEROS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 RED OAK PL
CHULA VISTA CA
91910-6750
US

IV. Provider business mailing address

1008 RED OAK PL
CHULA VISTA CA
91910-6750
US

V. Phone/Fax

Practice location:
  • Phone: 619-646-8283
  • Fax: 619-330-4931
Mailing address:
  • Phone: 619-646-8283
  • Fax: 619-330-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: