Provider Demographics
NPI:1407315575
Name:LARTITEGUI, AITOR
Entity type:Individual
Prefix:
First Name:AITOR
Middle Name:
Last Name:LARTITEGUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15481 SW 12TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1993
Mailing Address - Country:US
Mailing Address - Phone:954-530-8460
Mailing Address - Fax:954-533-0087
Practice Address - Street 1:15481 SW 12TH ST STE 303
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1993
Practice Address - Country:US
Practice Address - Phone:954-530-8460
Practice Address - Fax:954-533-0087
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician