=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821216904
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISA JOY LAND MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 12/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 S BARRINGTON AVE STE 301
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-5379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-428-2833
-----------------------------------------------------
Fax | 888-558-6693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1535 FERNWOOD PACIFIC DR
-----------------------------------------------------
City | TOPANGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90290-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-428-2833
-----------------------------------------------------
Fax | 888-558-6693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A95967
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------