=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932207107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK LANDON MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 477 N EL CAMINO REAL STE C100
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-942-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25033
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92799-5033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-347-1000
-----------------------------------------------------
Fax | 714-347-1082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK LANDON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-347-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A48586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------