Healthcare Provider Details

I. General information

NPI: 1215560693
Provider Name (Legal Business Name): ITALIA LAROCCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

600 B ST STE 1570
SAN DIEGO CA
92101-4560
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0439
  • Fax:
Mailing address:
  • Phone: 619-615-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN95212981
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95212981
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN95212981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: