Provider Demographics
NPI:1043391584
Name:LAROSE, JAMES RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:LAROSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3402
Mailing Address - Country:US
Mailing Address - Phone:909-985-2555
Mailing Address - Fax:909-985-0068
Practice Address - Street 1:1060 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3785
Practice Address - Country:US
Practice Address - Phone:909-985-2555
Practice Address - Fax:909-985-0068
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480029125OtherMEDICARE RAILROAD
CAZZZ80594ZMedicaid
CA6501520001OtherMEDICARE NSC
CA6501520001OtherMEDICARE NSC
CA480029125OtherMEDICARE RAILROAD