Provider Demographics
NPI:1144520388
Name:KARAZHOVA, LARISA (FNP)
Entity type:Individual
Prefix:MS
First Name:LARISA
Middle Name:
Last Name:KARAZHOVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:LEVINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5038 LAUREL CANYON BLVD APT 106
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-769-5462
Mailing Address - Fax:
Practice Address - Street 1:5038 LAUREL CANYON BLVD APT 106
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-769-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20335207Q00000X
CA20335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine