Provider Demographics
NPI:1912947896
Name:RAMIREZ, LARISSA K (PAC)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:K
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:K
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-8606
Practice Address - Country:US
Practice Address - Phone:281-364-8001
Practice Address - Fax:281-364-8004
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA4359363A00000X
TXPA04359363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant