Provider Demographics
NPI:1487769063
Name:LANDO, ULF (MD)
Entity type:Individual
Prefix:
First Name:ULF
Middle Name:
Last Name:LANDO
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 1:16133 VENTURA BLVD
Mailing Address - Street 2:#350
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-986-1446
Mailing Address - Fax:818-789-5846
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:#350
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-986-1446
Practice Address - Fax:818-789-5846
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A355580Medicaid
CA00A355580Medicaid
CAA35558AMedicare PIN