Healthcare Provider Details

I. General information

NPI: 1548561558
Provider Name (Legal Business Name): OSCAR GABRIEL LARRAZOLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2010
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 NORTH 15TH STREET WEST SUITE 105
LANCASTER CA
93534
US

IV. Provider business mailing address

26635 MACMILLAN RANCH RD
SANTA CLARITA CA
91387-4037
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5460
  • Fax:
Mailing address:
  • Phone: 951-236-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: