Healthcare Provider Details

I. General information

NPI: 1285782136
Provider Name (Legal Business Name): LARUE LAPORTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

IV. Provider business mailing address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

V. Phone/Fax

Practice location:
  • Phone: 808-803-3370
  • Fax:
Mailing address:
  • Phone: 888-803-3370
  • Fax: 888-803-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: