Provider Demographics
NPI:1558688820
Name:LAROCCA, CECILIA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ALEJANDRA
Last Name:LAROCCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N CHARLES ST
Mailing Address - Street 2:APT. 1511
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4021
Mailing Address - Country:US
Mailing Address - Phone:646-483-8936
Mailing Address - Fax:
Practice Address - Street 1:218 N CHARLES ST
Practice Address - Street 2:APT. 1511
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4021
Practice Address - Country:US
Practice Address - Phone:646-483-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265984207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology