Provider Demographics
NPI:1497961197
Name:SZEYKO, LARISSA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:ANNE
Last Name:SZEYKO
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 1:5500 VENTANA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3448
Mailing Address - Country:US
Mailing Address - Phone:520-469-8168
Mailing Address - Fax:
Practice Address - Street 1:2101 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3346
Practice Address - Country:US
Practice Address - Phone:915-577-7840
Practice Address - Fax:915-577-7822
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7675207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease