Provider Demographics
NPI:1447537451
Name:LANDEROS, HAIDE (FNP)
Entity type:Individual
Prefix:
First Name:HAIDE
Middle Name:
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:866-646-3553
Mailing Address - Fax:562-622-2803
Practice Address - Street 1:415 OLD NEWPORT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4252
Practice Address - Country:US
Practice Address - Phone:949-548-9611
Practice Address - Fax:949-548-9958
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21200363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner