Provider Demographics
NPI:1427813252
Name:LIMON, LARISA (HIS)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LIMON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 LAS GALLINAS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3431
Mailing Address - Country:US
Mailing Address - Phone:415-492-8888
Mailing Address - Fax:415-492-8583
Practice Address - Street 1:750 LAS GALLINAS AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3431
Practice Address - Country:US
Practice Address - Phone:415-492-8888
Practice Address - Fax:415-492-8583
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8944237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist