Provider Demographics
NPI:1649566837
Name:LARISSA A SZEYKO, M D PLLC
Entity Type:Organization
Organization Name:LARISSA A SZEYKO, M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SZEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-250-6184
Mailing Address - Street 1:4 MINA PERDIDA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2204
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:520-351-6601
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7675207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty