Provider Demographics
NPI:1669946216
Name:LANDEROS, KATHERINE N (MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:N
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7402
Mailing Address - Country:US
Mailing Address - Phone:760-815-9056
Mailing Address - Fax:
Practice Address - Street 1:35317 TRAILSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2593
Practice Address - Country:US
Practice Address - Phone:562-322-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician