Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G380560 | CA |
Y | 2080P0201X | Pediatric Allergist | G380560 | CA |
NPI | 1427118868 |
---|---|
Provider Name | Chris Landon |
First Address | Ventura, CA 93003-2918 |
Second Address | Ventura, CA 93003-3099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 07/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G380560 | (05) | CA |
A89652 | (02) | CA |