Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20A7021 | CA |
N | 111NI0900X | Internist | 20A7021 | CA |
Y | 207RR0500X | Rheumatology | 20A7021 | CA |
NPI | 1053471045 |
---|---|
Provider Name | Dr. Andre P. Lallande |
First Address | Fontana, CA 92336-5159 |
Second Address | Fontana, CA 92336-5159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 18/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05D0575313 | CLIA # FOR GROUP (01) | CA |
G60960 | (02) | CA |
ZZZ34392Z | MEDICARE GROUP ID (01) | CA |