Healthcare Provider Details

I. General information

NPI: 1003774464
Provider Name (Legal Business Name): VEIN CLINIC OF ST CLOUD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E 13TH ST
SAINT CLOUD FL
34769-4701
US

IV. Provider business mailing address

720 W OAK ST STE 309
KISSIMMEE FL
34741-4910
US

V. Phone/Fax

Practice location:
  • Phone: 321-436-1783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE ANTONIO LARRANAGA
Title or Position: OWNER
Credential: MD
Phone: 321-436-1783