MEDICARE: LARISSA JEANETTE MOONEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A92391	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A923910	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1942238282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA JEANETTE MOONEY M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:	310-206-8387

Provider Business Practice Location Address
First Line	:	300 UCLA MEDICAL PLZ STE 2200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7534
Country	:	US
Telephone Number	:	310-825-9989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/18/2024

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