Provider Demographics
NPI:1881887776
Name:NEGRON, LARISSA R (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:R
Last Name:NEGRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7635 ASHLEY PARK CT STE 501
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6196
Mailing Address - Country:US
Mailing Address - Phone:407-960-0260
Mailing Address - Fax:407-295-3080
Practice Address - Street 1:7635 ASHLEY PARK CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-960-0260
Practice Address - Fax:407-295-3080
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35090237208000000X
ARE-6794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AH79Medicare PIN