Provider Demographics
NPI:1770225104
Name:LARRIVA, RAYMOND CHARLES (PSYCHIATRIC TECH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:LARRIVA
Suffix:
Gender:M
Credentials:PSYCHIATRIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13563 GRAY HAWK CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8897
Mailing Address - Country:US
Mailing Address - Phone:626-705-1822
Mailing Address - Fax:
Practice Address - Street 1:13563 GRAY HAWK CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8897
Practice Address - Country:US
Practice Address - Phone:626-705-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician