Provider Demographics
NPI:1891888327
Name:LARRETA, BORIS RAMIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:RAMIRO
Last Name:LARRETA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3452 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3142
Mailing Address - Country:US
Mailing Address - Phone:626-793-2885
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-848-6404
Practice Address - Fax:818-848-7112
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-07-01
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Provider Licenses
StateLicense IDTaxonomies
CAG49084207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG49840Medicaid
CAHW7714Medicare PIN
CAOOG49840Medicaid
CADM963YMedicare PIN