Healthcare Provider Details

I. General information

NPI: 1316610652
Provider Name (Legal Business Name): BETTY LEE LANDEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 E HATCHWAY ST
COMPTON CA
90222-2520
US

IV. Provider business mailing address

2113 E HATCHWAY ST
COMPTON CA
90222-2520
US

V. Phone/Fax

Practice location:
  • Phone: 310-930-5646
  • Fax:
Mailing address:
  • Phone: 310-930-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: