Provider Demographics
NPI:1104072719
Name:ZABOKRITSKAYA, LARISA (RN, NP)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:
Last Name:ZABOKRITSKAYA
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 FIJI WAY UNIT J
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7071
Mailing Address - Country:US
Mailing Address - Phone:310-827-6750
Mailing Address - Fax:
Practice Address - Street 1:13209 FIJI WAY UNIT J
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7071
Practice Address - Country:US
Practice Address - Phone:310-827-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA681341363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner