Provider Demographics
NPI:1497775266
Name:MURAKAMI, LARISSA (OD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:MURAKAMI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12759 FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9336
Mailing Address - Country:US
Mailing Address - Phone:909-899-0026
Mailing Address - Fax:909-899-6381
Practice Address - Street 1:12759 FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9336
Practice Address - Country:US
Practice Address - Phone:909-899-0026
Practice Address - Fax:909-899-6381
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11186T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76898Medicare UPIN