Healthcare Provider Details

I. General information

NPI: 1356383616
Provider Name (Legal Business Name): DONNA LANDTWING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 MONTEREY DR
EL CAJON CA
92020-6718
US

IV. Provider business mailing address

1161 MONTEREY DR
EL CAJON CA
92020-6718
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-9949
  • Fax: 619-588-1750
Mailing address:
  • Phone: 619-647-9021
  • Fax: 619-588-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG57798
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG57798
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG57798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: