Provider Demographics
NPI:1407022106
Name:LARIVIERE, LORI LORAINE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LORAINE
Last Name:LARIVIERE
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 1:4127 NORD HWY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9631
Mailing Address - Country:US
Mailing Address - Phone:612-723-6417
Mailing Address - Fax:
Practice Address - Street 1:4127 NORD HWY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9631
Practice Address - Country:US
Practice Address - Phone:612-723-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1466602084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260003874Medicare PIN