=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992448138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRAINE HO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2022
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5841 E QUARTZ MOUNTAIN RD
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-670-0188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5841 E QUARTZ MOUNTAIN RD
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 22367
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------