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NPI Code Detail

MEDICARE: DR. JOSHUA EBENEZER LANDAVASO I MD

MEDICARE: DR. JOSHUA EBENEZER LANDAVASO I MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1053014738
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSHUA EBENEZER LANDAVASO I MD
Provider Business Mailing Address
First Line : 2776 W CALLE ARANDAS
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2535
Country : US
Telephone Number : 928-451-5703
Fax Number :
Provider Business Practice Location Address
First Line : 1101 26TH ST S
Second Line :
City : GREAT FALLS
State : MT
Zip : 59405-5161
Country : US
Telephone Number : 580-481-4130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 05/27/2026

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