Provider Demographics
NPI:1922795368
Name:LARRAURI, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:LARRAURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 NW 33RD ST UNIT 5201
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2477
Mailing Address - Country:US
Mailing Address - Phone:954-681-7257
Mailing Address - Fax:
Practice Address - Street 1:897 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3473
Practice Address - Country:US
Practice Address - Phone:407-201-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB911787106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician