1649910589 NPI number — LUIS ALESANDRO LARRAZABAL MARTINEZ MD PC

Table of content: DR. MEREDITH LYNN PETTY PHARMD (NPI 1174722730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649910589 NPI number — LUIS ALESANDRO LARRAZABAL MARTINEZ MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUIS ALESANDRO LARRAZABAL MARTINEZ MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649910589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 RHODE ISLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94107-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4153 24TH ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94114-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-599-0988
Provider Business Practice Location Address Fax Number:
866-651-0173
Provider Enumeration Date:
03/30/2022

Additional Information

Authorized Official

Authorized Official Last Name:
LARRAZABAL MARTINEZ
Authorized Official First Name:
LUIS ALESANDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
415-599-0988

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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