Provider Demographics
NPI:1871655274
Name:LANDIS, CLAUDIA A (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:A
Last Name:LANDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N WATERMAN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-381-1595
Mailing Address - Fax:909-381-3291
Practice Address - Street 1:1500 N WATERMAN
Practice Address - Street 2:SUITE B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-381-1595
Practice Address - Fax:909-381-3291
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60638207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60638Medicaid
CAG60638Medicaid
CAG60638Medicare ID - Type Unspecified