Provider Demographics
NPI:1790312098
Name:HAGGE, LANDIN PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:LANDIN
Middle Name:PAUL
Last Name:HAGGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3828
Mailing Address - Country:US
Mailing Address - Phone:801-921-0612
Mailing Address - Fax:
Practice Address - Street 1:1111 N NAGLE ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3840
Practice Address - Country:US
Practice Address - Phone:530-708-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A2028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine