Provider Demographics
NPI:1306988977
Name:LANDAW, ROBERT MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:LANDAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:#206
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6513
Mailing Address - Country:US
Mailing Address - Phone:310-826-5513
Mailing Address - Fax:310-820-1606
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:#206
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90049-6513
Practice Address - Country:US
Practice Address - Phone:310-826-5513
Practice Address - Fax:310-820-1606
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics