1053809046 NPI number — BEATRIZ ELENA LARROUDE ED.D., CCC-SLP

Table of content: BEATRIZ ELENA LARROUDE ED.D., CCC-SLP (NPI 1053809046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053809046 NPI number — BEATRIZ ELENA LARROUDE ED.D., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARROUDE
Provider First Name:
BEATRIZ
Provider Middle Name:
ELENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.D., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LARROUDE
Provider Other First Name:
BETTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.D., CCC-SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053809046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3640 GRAND AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94610-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-986-1476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 GRAND AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94610-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-986-1476
Provider Business Practice Location Address Fax Number:
510-986-1476
Provider Enumeration Date:
04/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP9516 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com