Provider Demographics
NPI:1962007435
Name:BROOKS, LARYSA
Entity Type:Individual
Prefix:
First Name:LARYSA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARYSA
Other - Middle Name:
Other - Last Name:BOCHAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1718 E LINCOLN RD APT L3078
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7790
Mailing Address - Country:US
Mailing Address - Phone:253-273-7989
Mailing Address - Fax:
Practice Address - Street 1:1718 E LINCOLN RD APT L3078
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7790
Practice Address - Country:US
Practice Address - Phone:253-273-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter