Provider Demographics
NPI:1740758606
Name:LANDRY'S ELITE MEDICAL ENTERPRISE, PLLC
Entity Type:Organization
Organization Name:LANDRY'S ELITE MEDICAL ENTERPRISE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-282-7477
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90078-2867
Mailing Address - Country:US
Mailing Address - Phone:310-857-8436
Mailing Address - Fax:
Practice Address - Street 1:3204 MELODY PEAK LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-2555
Practice Address - Country:US
Practice Address - Phone:310-857-8436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty