Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | C35538 | CA |
Y | 207PE0004X | Emergency Medical Services | C35538 | CA |
N | 207PP0204X | Pediatric Emergency Physician | C35538 | CA |
NPI | 1083630883 |
---|---|
Provider Name | Larry Jack Baraff |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 22/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C355380 | (05) | CA |