Provider Demographics
NPI:1073575320
Name:LARRANAGA, ANTONIO J JR (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:J
Last Name:LARRANAGA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11863 DELFINA LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7105
Mailing Address - Country:US
Mailing Address - Phone:850-496-2727
Mailing Address - Fax:
Practice Address - Street 1:711 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4573
Practice Address - Country:US
Practice Address - Phone:407-846-0533
Practice Address - Fax:407-518-1730
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME674992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377037100Medicaid
FLC11531Medicare UPIN
FL377037100Medicaid