Provider Demographics
NPI:1184146466
Name:LANDRIO, TANYA DENISE (NP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:DENISE
Last Name:LANDRIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SANTA FE AVE APT 583
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-3114
Mailing Address - Country:US
Mailing Address - Phone:303-720-9974
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 809
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3909
Practice Address - Country:US
Practice Address - Phone:303-720-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty