Provider Demographics
NPI:1427676048
Name:LAROSA, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LAROSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2406
Mailing Address - Country:US
Mailing Address - Phone:831-754-3635
Mailing Address - Fax:
Practice Address - Street 1:755 SAINT HELEN WAY
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2122
Practice Address - Country:US
Practice Address - Phone:904-536-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95177611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse