Provider Demographics
NPI:1174527139
Name:LANDA, DANIEL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM
Last Name:LANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N HARBOR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4107
Mailing Address - Country:US
Mailing Address - Phone:714-578-0533
Mailing Address - Fax:714-578-0548
Practice Address - Street 1:1400 N HARBOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4107
Practice Address - Country:US
Practice Address - Phone:714-578-0533
Practice Address - Fax:714-578-0548
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33509207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33509Medicare ID - Type Unspecified
CAA89554Medicare UPIN