Healthcare Provider Details

I. General information

NPI: 1982532610
Provider Name (Legal Business Name): PATRICK LANDEROS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 STERN AVE APT 10
SHERMAN OAKS CA
91423-3582
US

IV. Provider business mailing address

4350 STERN AVE APT 10
SHERMAN OAKS CA
91423-3582
US

V. Phone/Fax

Practice location:
  • Phone: 949-412-7340
  • Fax:
Mailing address:
  • Phone: 949-412-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000039827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: