Basic Information
| Provider Information | |||||||||
| NPI: | 1699215277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARRAIN | ||||||||
| FirstName: | RICARDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SOUTH DELANO #2 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183996673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136392660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2017 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT35645 | CT | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.