Individual
DR. ANDRE P. LALLANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5726 RIDGEMARK PL, FONTANA, CA 92336-5159
(909) 559-1050
Mailing address
5726 RIDGEMARK PL, FONTANA, CA 92336-5159
(909) 559-1050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20A7021
CA
207RR0500X
Rheumatology Physician
Primary
20A7021
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0575313
CLIA # FOR GROUP
CA
01
—
ZZZ34392Z
MEDICARE GROUP ID
CA
Enumeration date
12/11/2006
Last updated
02/18/2021
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