Provider Demographics
NPI:1548150097
Name:LANDA, CRISTAL ABIGAIL
Entity type:Individual
Prefix:
First Name:CRISTAL
Middle Name:ABIGAIL
Last Name:LANDA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 S CORNING ST APT 19
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2451
Mailing Address - Country:US
Mailing Address - Phone:310-502-6163
Mailing Address - Fax:310-502-6163
Practice Address - Street 1:1120 S 18TH ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3654
Practice Address - Country:US
Practice Address - Phone:509-573-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADERE.RR.61671125390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program