Provider Demographics
NPI:1306032495
Name:LANDER, MARLA R (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:R
Last Name:LANDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:81812 DR CARREON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5594
Mailing Address - Country:US
Mailing Address - Phone:760-775-5378
Mailing Address - Fax:760-775-5371
Practice Address - Street 1:81812 DR CARREON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5594
Practice Address - Country:US
Practice Address - Phone:760-775-5378
Practice Address - Fax:760-775-5371
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG739122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48386Medicare UPIN
CA00G739120Medicare PIN