Provider Demographics
NPI:1659536480
Name:ALLEN, LARISSA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:MARIA
Last Name:ALLEN
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 1:6130 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3557
Mailing Address - Country:US
Mailing Address - Phone:520-219-8342
Mailing Address - Fax:520-219-7117
Practice Address - Street 1:6130 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-219-8342
Practice Address - Fax:520-219-7117
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48787207RG0100X
AZR70554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine