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General NPI Number Information
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NPI Number | 1699215277
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Entity Type | Individual
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Provider Name | RICARDO LARRAIN
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Gender | Male
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-639-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SOUTH DELANO #2
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City | ANAHEIM
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State | CA
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Zip | 92804
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Country | US
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Telephone | 818-399-6673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | PT35645
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License Number State | CT
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