Provider Demographics
NPI:1225201841
Name:RICARDO J. LARRAIN M.D., P.A.
Entity Type:Organization
Organization Name:RICARDO J. LARRAIN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-736-1404
Mailing Address - Street 1:800 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3215
Mailing Address - Country:US
Mailing Address - Phone:386-736-1404
Mailing Address - Fax:386-736-1423
Practice Address - Street 1:800 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3215
Practice Address - Country:US
Practice Address - Phone:386-736-1404
Practice Address - Fax:386-736-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062589207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF34609Medicare UPIN
FL38527Medicare PIN