Provider Demographics
NPI:1780335620
Name:LANDAVAZO, MEGAN K (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:LANDAVAZO
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:5548 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1130
Mailing Address - Country:US
Mailing Address - Phone:109-254-1378
Mailing Address - Fax:
Practice Address - Street 1:4326 LAS POSITAS RD STE 123
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9641
Practice Address - Country:US
Practice Address - Phone:925-413-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer