Provider Demographics
NPI:1346257706
Name:LANDREY, WILLIAM CHRISTOPHER (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:LANDREY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9474 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5822
Mailing Address - Country:US
Mailing Address - Phone:909-987-3211
Mailing Address - Fax:909-987-0317
Practice Address - Street 1:9474 BASELINE RD
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5822
Practice Address - Country:US
Practice Address - Phone:909-987-3211
Practice Address - Fax:909-987-0317
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1457213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2500280001OtherDME
CA000E14570Medicaid
CA000E14571Medicaid
CAT10967OtherUPIN
CA000E14570Medicaid
CAT10967OtherUPIN
CA2500280001OtherDME
CA000E14570Medicare UPIN