Provider Demographics
NPI:1922386549
Name:SALAS, LARISSA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MARIE
Last Name:SALAS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3326
Mailing Address - Fax:201-570-7802
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3326
Practice Address - Fax:215-707-8028
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019130207L00000X
PAOS018166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology