Healthcare Provider Details

I. General information

NPI: 1275498982
Provider Name (Legal Business Name): MERINA CARMEL LANDSMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 N PITTSBURG ST STE B
KENNEWICK WA
99336-7216
US

IV. Provider business mailing address

107 N 69TH AVE
WEST RICHLAND WA
99353-9276
US

V. Phone/Fax

Practice location:
  • Phone: 509-870-4170
  • Fax:
Mailing address:
  • Phone: 509-405-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: