RICARDO J. LARRAIN M.D., P.A.
Medical Practice at Plymouth Ave, Deland, FL

License number
Florida ME0062589
Category
Medical Practice
Type
Obstetrics
Owner
Name: DR. RICARDO J LARRAIN M.D.
Title: OWNER
Phone: (386) 736-1404
Address
Address
800 W Plymouth Ave, Deland, FL 32720
National Provider ID: 1225201841
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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RICARDO J. LARRAIN, M.D., PA

800 W Plymouth Ave, Deland, FL 32720

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Nov 1, 1977
Inactive since:
Aug 8, 2005
State ID:
548901
Business type:
Florida Profit Corporation
President, Treasurer, Secretary, Directors:
Larrain, Ricardo J, Dr,Ricardo J. Larrain (President, Treasurer, Secretary, Director)
Agent:
Ricardo J. Larrain,800 W Plymouth Ave, Deland, FL 32720 (Physical)
EIN:
591783270

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