1639464803 NPI number — DR. MARIA E LARRAZALETA M.D.

Table of content: DR. MARIA E LARRAZALETA M.D. (NPI 1639464803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639464803 NPI number — DR. MARIA E LARRAZALETA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARRAZALETA
Provider First Name:
MARIA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1639464803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 S MESA HILLS DR
Provider Second Line Business Mailing Address:
APT 3803
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-308-1851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9398 VISCOUNT
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-629-0442
Provider Business Practice Location Address Fax Number:
915-629-0552
Provider Enumeration Date:
06/15/2011

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: 207V00000X , with the licence number:  Q5209 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q5209 . This is a "TX MEDICAL LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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