Provider Demographics
NPI:1659466316
Name:KALIFE, LARISSA (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:KALIFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18040 SHERMAN WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4656
Mailing Address - Country:US
Mailing Address - Phone:424-421-6001
Mailing Address - Fax:818-239-4239
Practice Address - Street 1:18040 SHERMAN WAY STE 210
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4656
Practice Address - Country:US
Practice Address - Phone:424-421-6001
Practice Address - Fax:818-239-4239
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27988Medicare UPIN
CAA67077Medicare ID - Type Unspecified