Provider Demographics
NPI:1811906753
Name:GARBAR, LARISA (MD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:GARBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90707-1682
Mailing Address - Country:US
Mailing Address - Phone:562-229-9452
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:2220 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2521
Practice Address - Country:US
Practice Address - Phone:562-597-4181
Practice Address - Fax:562-597-7083
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71864207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A718640OtherBLUE SHIELD
CA00A718640OtherBLUE SHIELD
CAWA71864AMedicare ID - Type Unspecified