Provider Demographics
NPI:1518959824
Name:MARLA R LANDER
Entity Type:Organization
Organization Name:MARLA R LANDER
Other - Org Name:THE BREAST HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-775-5378
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73912261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
G48386Medicare UPIN
00G739120Medicare ID - Type Unspecified