INDIE C OLIVER LANDRUM (NPI# 1063938587) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063938587 |
| Entity Type | Individual |
| Full Name | INDIE C OLIVER LANDRUM |
| Other Name | ANKA CARROLL LANDRUM |
| Practice Address |
2220 Broadway San Diego CA 92104 |
| Mailing Address |
2220 Broadway San Diego CA 92102-1926 |
| Practice Telephone | (619) 232-8126 |
| Mailing Telephone | 6192328126 |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2017-08-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
2220 BROADWAY |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225651722 | Gabriel Victor Mendonca De Souza | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92102-1926 | 2020-05-19 |
| 1548890676 | Dung Mang King | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92102-1926 | 2020-01-16 |
| 1942776273 | Mary Delaney O'keefe | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92102-1926 | 2018-10-14 |
| 1710452719 | Karla Mendoza | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92102-1926 | 2018-10-05 |
| 1972002541 | Alicia Montellanos | Peer Specialist | 2220 Broadway, San Diego, CA 92102-1926 | 2018-02-08 |
| 1487164547 | Melanie Martellaro | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92102-1926 | 2017-10-03 |
| 1366968802 | Van Ethan Levy | Counselor | 2220 Broadway, San Diego, CA 92102-1926 | 2017-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750933610 | Hinderberger Dental Corporation | Dentist | 2050 El Cajon Boulevard, San Diego, CA 92104 | 2019-07-11 |
| 1912487265 | Graham Ashton Harris | Dentist | 2310 Craven Street, Bldg 3230, Fpo, AA 92104 | 2018-08-16 |
| 1700393485 | Christian Jacot | Occupational Therapy Assistant | 3128 Nile Street, San Diego, CA 92104 | 2018-01-04 |
| 1316452931 | Enrico Resurreccion Santos | Dental Hygienist | 2310 Craven St. Bldg. 3230, San Diego, CA 92104 | 2017-12-05 |
| 1164940789 | Robert Brian Damone | Acupuncturist | 3370 29th Street, San Diego, CA 92104 | 2017-09-04 |
| 1780100636 | Nicole Palacios | Counselor | 4170 Texas Street, Apt 1, San Diego, CA 92104 | 2017-08-22 |
| 1669829008 | Krystah Lynn Smith | Doula | 3370 Cherokee Ave, Unit 43, San Diego, CA 92104 | 2016-05-16 |
| 1063871853 | Holly Nicole Hinderberger | Dentist | 2050 El Cajon Blvd, San Diego, CA 92104 | 2016-02-22 |
| 1316336258 | Jorge E Talavera | Military Health Care Provider | 3875 Florida St Apt 2, San Diego, CA 92104 | 2015-01-15 |
| 1679872022 | Lauren Carrillo | Chiropractor | 3618 Quince St, San Diego, CA 92104 | 2011-03-24 |
| Find all providers in zip 92104 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457963738 | Diyana Giorgees | Case Manager/Care Coordinator | 5005 Texas Street, St. 203, San Diego, CA 92108 | 2020-08-19 |
| 1770105439 | Timothy Mccloud | Case Manager/Care Coordinator | 6160 Mission Gorge Rd # 108, San Diego, CA 92120-3410 | 2020-05-15 |
| 1043846272 | Daniel Rafael Martinez | Case Manager/Care Coordinator | 8825 Aero Dr Ste 305, San Diego, CA 92123-2270 | 2020-03-19 |
| 1043844376 | Ariel A Anderson | Case Manager/Care Coordinator | 8501 Larkdale Ave, San Diego, CA 92123-2047 | 2020-02-25 |
| 1124664818 | Sarah Milan | Case Manager/Care Coordinator | 1846 30th St Apt A, San Diego, CA 92102-1145 | 2019-11-18 |
| 1750930814 | Christine Guianne Mupas Ramos | Case Manager/Care Coordinator | 1660 Hotel Cir N # 320, San Diego, CA 92108-2807 | 2019-09-10 |
| 1437708518 | Brendan Domingo Guerra | Case Manager/Care Coordinator | 5617 Vista San Juanico, San Diego, CA 92154-5672 | 2019-09-10 |
| 1457912982 | Kendra Crater | Case Manager/Care Coordinator | 3481 Kurtz St, San Diego, CA 92110-4430 | 2019-06-25 |
| 1790342319 | Ariella Beth Darlington | Case Manager/Care Coordinator | 3644 Princeton Ave, San Diego, CA 92117-5637 | 2019-05-20 |
| 1013572361 | Brandon Joel Jessie | Case Manager/Care Coordinator | 1250 Morena Blvd Bldg 2nd, San Diego, CA 92110-3815 | 2019-05-02 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.