Provider Demographics
NPI:1346525557
Name:MARISSA N. LARGOZA, M.D., P.A.
Entity Type:Organization
Organization Name:MARISSA N. LARGOZA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LARGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-692-0404
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 191
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-692-0404
Mailing Address - Fax:210-692-9202
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 191
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-692-0404
Practice Address - Fax:210-692-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG74341Medicare UPIN