Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP5217 | AZ |
NPI | 1033546072 |
---|---|
Provider Name | Mr. Paul Eric Larralde |
First Address | Scottsdale, AZ 85250-4421 |
Second Address | Scottsdale, AZ 85250-4421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2013 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
859900 | (05) | AZ |
859900 | AHCCCS (01) | AZ |
Z162628 | MEDICARE (01) | AZ |