Provider Demographics
NPI:1821632357
Name:LANDA, ERIN JOY
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JOY
Last Name:LANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 PINEGATE DR APT 229
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2911
Mailing Address - Country:US
Mailing Address - Phone:254-744-0569
Mailing Address - Fax:
Practice Address - Street 1:2220 PINEGATE DR APT 229
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2911
Practice Address - Country:US
Practice Address - Phone:254-744-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty