Provider Demographics
NPI:1851608343
Name:LANDEROS, ANTULIO TAYLOR
Entity Type:Individual
Prefix:
First Name:ANTULIO
Middle Name:TAYLOR
Last Name:LANDEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9394
Mailing Address - Country:US
Mailing Address - Phone:559-624-8000
Mailing Address - Fax:559-713-3244
Practice Address - Street 1:11150 AVENUE 368
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8940
Practice Address - Country:US
Practice Address - Phone:559-735-1353
Practice Address - Fax:559-713-3296
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator