Healthcare Provider Details

I. General information

NPI: 1962133983
Provider Name (Legal Business Name): DHYANA LANDA RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 MOTOR AVE STE 100
LOS ANGELES CA
90034-5745
US

IV. Provider business mailing address

3685 MOTOR AVE STE 100
LOS ANGELES CA
90034-5745
US

V. Phone/Fax

Practice location:
  • Phone: 323-987-3736
  • Fax: 323-800-5416
Mailing address:
  • Phone: 323-987-3736
  • Fax: 323-800-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95078094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: