Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | G37378 | CA |
NPI | 1184777567 |
---|---|
Provider Name | Robert Landman |
First Address | Stockton, CA 95219-2369 |
Second Address | Santa Rosa, CA 95405-7815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G373780 | MEDI-CAL (01) | CA |
A47062 | (02) | |
G37378 | MD LICENSE (01) | CA |