Provider Demographics
NPI:1033409271
Name:GIULIANO, LARISSA FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:FAYE
Last Name:GIULIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LARISSA
Other - Middle Name:FAYE
Other - Last Name:KRAUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-743-8200
Mailing Address - Fax:918-743-8609
Practice Address - Street 1:7912 E 31ST CT
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1315
Practice Address - Country:US
Practice Address - Phone:918-743-8200
Practice Address - Fax:918-743-8609
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine