Provider Demographics
NPI:1265991210
Name:LANDA, ROCIO BERNADETTE (HS DIPLOMA)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:BERNADETTE
Last Name:LANDA
Suffix:
Gender:F
Credentials:HS DIPLOMA
Other - Prefix:
Other - First Name:ROCIO
Other - Middle Name:BERNADETTE
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HE'S DIPLOMA
Mailing Address - Street 1:31180 96TH ST E
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:CA
Mailing Address - Zip Code:93543-3624
Mailing Address - Country:US
Mailing Address - Phone:818-489-4270
Mailing Address - Fax:
Practice Address - Street 1:31180 96TH ST E
Practice Address - Street 2:
Practice Address - City:LITTLEROCK
Practice Address - State:CA
Practice Address - Zip Code:93543-3624
Practice Address - Country:US
Practice Address - Phone:818-489-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst