Provider Demographics
NPI:1689285736
Name:LARISSA KALIFE MD
Entity Type:Organization
Organization Name:LARISSA KALIFE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-421-6001
Mailing Address - Street 1:1125 S BEVERLY DR STE 720
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1180
Mailing Address - Country:US
Mailing Address - Phone:424-421-6001
Mailing Address - Fax:818-239-4239
Practice Address - Street 1:1125 S BEVERLY DR STE 720
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1180
Practice Address - Country:US
Practice Address - Phone:424-421-6001
Practice Address - Fax:818-239-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty