Basic Information
| Provider Information | |||||||||
| NPI: | 1538643887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | LANDON | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7262 S BRITTANY PARK AVE | ||||||||
| Address2: | |||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840844605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015031406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9710 BRIMHALL RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933122779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618296747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2018 | ||||||||
| LastUpdateDate: | 09/22/2018 | ||||||||
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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 | 363AM0700X | 55999 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.