Provider Demographics
NPI:1659631661
Name:DR. YOLANDA HERRERO-LANDIG D.D.S., INC.
Entity Type:Organization
Organization Name:DR. YOLANDA HERRERO-LANDIG D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-920-3959
Mailing Address - Street 1:8340 VAN NUYS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3693
Mailing Address - Country:US
Mailing Address - Phone:818-920-3959
Mailing Address - Fax:
Practice Address - Street 1:8340 VAN NUYS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3693
Practice Address - Country:US
Practice Address - Phone:818-920-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39435305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821203241Medicaid