Provider Demographics
NPI:1164102133
Name:LARAYA FAMILY MEDICINE - MEDICINA FAMILAR LLC
Entity Type:Organization
Organization Name:LARAYA FAMILY MEDICINE - MEDICINA FAMILAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ARIA GHARAVI
Authorized Official - Last Name:LARAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-949-2316
Mailing Address - Street 1:PO BOX 931263
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1263
Mailing Address - Country:US
Mailing Address - Phone:901-949-2316
Mailing Address - Fax:
Practice Address - Street 1:6570 STAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2839
Practice Address - Country:US
Practice Address - Phone:901-949-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty