Provider Demographics
NPI:1679689921
Name:LANDERS, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:LANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:19950 RINALDI ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-403-2420
Practice Address - Fax:818-360-6036
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF53676Medicare UPIN
CA00G534830Medicare PIN
CAWG53483EMedicare PIN