Provider Demographics
NPI:1376811406
Name:LARISSE LEE MD PC
Entity Type:Organization
Organization Name:LARISSE LEE MD PC
Other - Org Name:L.A. VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-325-0400
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-325-0400
Mailing Address - Fax:818-325-0404
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE 704
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-325-0400
Practice Address - Fax:818-325-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty