Provider Demographics
NPI:1396903944
Name:DARVIN, LAARNI GUTIERREZ (MD)
Entity type:Individual
Prefix:
First Name:LAARNI
Middle Name:GUTIERREZ
Last Name:DARVIN
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 1:800 SWIFT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:8108 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-3264
Practice Address - Fax:509-735-5382
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98770208000000X
WAMD00048930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5612132Medicaid
CAGR0084521Medicaid
CAGR0084522Medicaid
WA1396903944Medicaid
CA6692132Medicaid
CAGR0084520Medicaid
CA7672132Medicaid