Provider Demographics
NPI:1588075220
Name:LANDGRAVE, OSCAR
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:LANDGRAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 E FLAMINGO RD
Mailing Address - Street 2:100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5249
Mailing Address - Country:US
Mailing Address - Phone:702-369-4357
Mailing Address - Fax:702-369-4089
Practice Address - Street 1:1640 E FLAMINGO RD
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5249
Practice Address - Country:US
Practice Address - Phone:702-369-4357
Practice Address - Fax:702-369-4089
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator