Provider Demographics
NPI:1033546072
Name:LARRALDE, PAUL ERIC (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ERIC
Last Name:LARRALDE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6619 N SCOTTSDALE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4421
Mailing Address - Country:US
Mailing Address - Phone:602-910-6519
Mailing Address - Fax:602-910-6519
Practice Address - Street 1:6619 N SCOTTSDALE RD STE 4
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-4421
Practice Address - Country:US
Practice Address - Phone:602-910-6519
Practice Address - Fax:602-910-6519
Is Sole Proprietor?:No
Enumeration Date:2013-10-06
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5217363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859900Medicaid
AZ859900OtherAHCCCS
AZZ162628OtherMEDICARE