Provider Demographics
NPI:1326235185
Name:COLON-RODRIGUEZ, LARISSA (MD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:COLON-RODRIGUEZ
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 1:1710 E SAUNDERS ST
Mailing Address - Street 2:SUITE B485
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5443
Mailing Address - Country:US
Mailing Address - Phone:956-712-2229
Mailing Address - Fax:956-712-2237
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:SUITE B485
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-712-2229
Practice Address - Fax:956-712-2237
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology