Provider Demographics
NPI:1669740924
Name:OGAWA, LARINDA (PA-C)
Entity type:Individual
Prefix:
First Name:LARINDA
Middle Name:
Last Name:OGAWA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 S MERIDIAN STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-848-3000
Mailing Address - Fax:253-845-8750
Practice Address - Street 1:5225 CIRQUE DR W STE 200
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3639
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:253-845-8750
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60583901363AM0700X, 363AM0700X
FLPA 9106335363AM0700X
ALPA-791363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07999OtherPHYSICIAN ASSISTANT
ALPA-791OtherALABAMA STATE BOARD OF MEDICAL EXAMINERS
FLPA 9106335OtherFLORIDA DEPARTMENT OF HEALTH