Provider Demographics
NPI:1366465759
Name:LANDETA, EDERLINA PECSON (MN, FNP)
Entity Type:Individual
Prefix:MS
First Name:EDERLINA
Middle Name:PECSON
Last Name:LANDETA
Suffix:
Gender:F
Credentials:MN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 ALONZO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1004
Mailing Address - Country:US
Mailing Address - Phone:818-345-4263
Mailing Address - Fax:818-677-6750
Practice Address - Street 1:18111 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8270
Practice Address - Country:US
Practice Address - Phone:818-677-3666
Practice Address - Fax:818-677-6750
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN343438363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094830OtherMEDI-CAL /FPACT