Provider Demographics
NPI:1265506067
Name:CANTER, LARISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:A
Last Name:CANTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-644-1112
Mailing Address - Fax:949-721-9676
Practice Address - Street 1:400 NEWPORT CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1112
Practice Address - Fax:949-721-9676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19191Medicare ID - Type Unspecified
CAH15439Medicare UPIN