Provider Demographics
NPI:1295004703
Name:LANDEROS, ROSSIO CABRERA (BS)
Entity Type:Individual
Prefix:
First Name:ROSSIO
Middle Name:CABRERA
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1704
Mailing Address - Country:US
Mailing Address - Phone:626-484-6544
Mailing Address - Fax:
Practice Address - Street 1:301 E ARROW HWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3364
Practice Address - Country:US
Practice Address - Phone:909-293-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor