Provider Demographics
NPI:1538589965
Name:LAYRISSE LANDAETA, LORENA MARGARITA (MD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:MARGARITA
Last Name:LAYRISSE LANDAETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 DEEP VALLEY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3749
Mailing Address - Country:US
Mailing Address - Phone:310-517-4692
Mailing Address - Fax:
Practice Address - Street 1:602 DEEP VALLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3749
Practice Address - Country:US
Practice Address - Phone:310-517-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172202207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine