Healthcare Provider Details

I. General information

NPI: 1437086345
Provider Name (Legal Business Name): LARREA ROYALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 ODESSA DR
CLOVER SC
29710-3619
US

IV. Provider business mailing address

2724 ODESSA DR
CLOVER SC
29710-3619
US

V. Phone/Fax

Practice location:
  • Phone: 980-888-2610
  • Fax:
Mailing address:
  • Phone: 980-888-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KARINA Y LARREA PINARGOTE
Title or Position: MANAGING MEMBER
Credential:
Phone: 704-771-4969