MEDICARE: DR. ALISA JOY LAND 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
1	2084P0800X	Psychiatry Physician	A95967	CA

General Provider Information

NPI Number	:	1821216904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA JOY LAND MD

Provider Business Mailing Address
First Line	:	1535 FERNWOOD PACIFIC DR
Second Line	:
City	:	TOPANGA
State	:	CA
Zip	:	90290-3234
Country	:	US
Telephone Number	:	310-428-2833
Fax Number	:	888-558-6693

Provider Business Practice Location Address
First Line	:	2001 S BARRINGTON AVE STE 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5379
Country	:	US
Telephone Number	:	310-428-2833
Fax Number	:	888-558-6693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	12/28/2021

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