Basic Information
| Provider Information | |||||||||
| NPI: | 1134481419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDRITO | ||||||||
| FirstName: | EARL JAY | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2087 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897022087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754455500 | ||||||||
| FaxNumber: | 7758880202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2874 N CARSON ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897061683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574455500 | ||||||||
| FaxNumber: | 7758880202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 03/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 17889 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.