Healthcare Provider Details

I. General information

NPI: 1932207107
Provider Name (Legal Business Name): MARK LANDON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE C100
ENCINITAS CA
92024-1332
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-8800
  • Fax:
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-347-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA48586
License Number StateCA

VIII. Authorized Official

Name: DR. MARK LANDON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-347-1010