Provider Demographics
NPI:1104844893
Name:LAROQUE, ELLY S (MD)
Entity Type:Individual
Prefix:
First Name:ELLY
Middle Name:S
Last Name:LAROQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 POST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3443
Mailing Address - Country:US
Mailing Address - Phone:415-776-7878
Mailing Address - Fax:
Practice Address - Street 1:2299 POST ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3443
Practice Address - Country:US
Practice Address - Phone:415-776-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79971207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP4310ZMedicare ID - Type Unspecified