Healthcare Provider Details

I. General information

NPI: 1619836368
Provider Name (Legal Business Name): CECILIA LANDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 N ORANGE GROVE AVE STE 104
POMONA CA
91767-3042
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 323-475-1809
  • Fax:
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: