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NPI Code Detail

MEDICARE: HAIDE LANDEROS FNP

MEDICARE: HAIDE LANDEROS FNP
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
1363L00000XNurse Practitioner21200CA
2363LF0000XFamily Nurse Practitioner21200CA

General Provider Information

NPI Number : 1447537451
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAIDE LANDEROS FNP
Provider Business Mailing Address
First Line : 12900 PARK PLAZA DR
Second Line : STE 150
City : CERRITOS
State : CA
Zip : 90703-9329
Country : US
Telephone Number : 866-646-3553
Fax Number : 562-622-2803
Provider Business Practice Location Address
First Line : 415 OLD NEWPORT BLVD STE 200
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-4252
Country : US
Telephone Number : 949-548-9611
Fax Number : 949-548-9958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 02/18/2020

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Directions to “ HAIDE LANDEROS FNP” Practice Location

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