Provider Demographics
NPI:1811941180
Name:LAROSA, STEVEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:LAROSA
Suffix:
Gender:M
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:AETHLON MEDICAL, INC.
Mailing Address - Street 2:11555 SORRENTO VALLEY ROAD
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-459-7800
Mailing Address - Fax:
Practice Address - Street 1:AETHLON MEDICAL, INC.
Practice Address - Street 2:11555 SORRENTO VALLEY ROAD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-459-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11364207RI0200X
TXN9888207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7056422Medicaid
RI007056422Medicare PIN