Provider Demographics
NPI:1114194271
Name:MAAMO, MARICAR LARRAGA
Entity Type:Individual
Prefix:
First Name:MARICAR
Middle Name:LARRAGA
Last Name:MAAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17806 KINZIE ST APT 117
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4782
Mailing Address - Country:US
Mailing Address - Phone:661-350-0993
Mailing Address - Fax:
Practice Address - Street 1:10349 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2421
Practice Address - Country:US
Practice Address - Phone:818-891-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist