Healthcare Provider Details

I. General information

NPI: 1316252893
Provider Name (Legal Business Name): LUIS ALESANDRO LARRAZABAL MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUIS ALESANDRO LARRAZABAL MD

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, #6M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1015 RHODE ISLAND ST
SAN FRANCISCO CA
94107-3214
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8361
  • Fax:
Mailing address:
  • Phone: 617-319-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU7458
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115533
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberU7458
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA115533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: