Individual
MS. BETH LANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1500 DUARTE RD, DUARTE, CA 91010-3012
(626) 359-8111
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12730
CA
363AM0700X
Medical Physician Assistant
PA12730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902846306
GROUP NPI
CA
01
—
GR0100430
GROUP MEDICAL
CA
05
—
PA12730
—
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
08/25/2006
Last updated
11/11/2020
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