Provider Demographics
NPI:1528188711
Name:TECHNIMED VERNON
Entity Type:Organization
Organization Name:TECHNIMED VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-584-7242
Mailing Address - Street 1:3364 E SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CA
Mailing Address - Zip Code:90058-3915
Mailing Address - Country:US
Mailing Address - Phone:323-584-7242
Mailing Address - Fax:714-899-4275
Practice Address - Street 1:3364 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-3915
Practice Address - Country:US
Practice Address - Phone:323-584-7242
Practice Address - Fax:714-899-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty