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General NPI Number Information
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NPI Number | 1306988977
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Entity Type | Individual
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Provider Name | ROBERT MARTIN LANDAW MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD #206
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City | LA
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State | CA
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Zip | 90049-6513
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Country | US
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Telephone | 310-826-5513
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Fax | 310-820-1606
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Provider Business Mailing Address
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Address Line | 11633 SAN VICENTE BLVD #206
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City | LA
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State | CA
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Zip | 90049-6513
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Country | US
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Telephone | 310-826-5513
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Fax | 310-820-1606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G9814
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License Number State | CA
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