Provider Demographics
NPI:1316610652
Name:LANDEROS, BETTY LEE
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:LEE
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 E HATCHWAY ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-2520
Mailing Address - Country:US
Mailing Address - Phone:310-930-5646
Mailing Address - Fax:
Practice Address - Street 1:2113 E HATCHWAY ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-2520
Practice Address - Country:US
Practice Address - Phone:310-930-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst