Provider Demographics
NPI:1851715627
Name:CHARTRAND, LARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:
Last Name:CHARTRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4500 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6888
Mailing Address - Country:US
Mailing Address - Phone:707-646-3286
Mailing Address - Fax:707-646-4886
Practice Address - Street 1:4520 BUSINESS CENTER DRIVE
Practice Address - Street 2:200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534
Practice Address - Country:US
Practice Address - Phone:707-646-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 120869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine