Healthcare Provider Details

I. General information

NPI: 1811941180
Provider Name (Legal Business Name): STEVEN P LAROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/29/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AETHLON MEDICAL, INC. 11555 SORRENTO VALLEY ROAD
SAN DIEGO CA
92121
US

IV. Provider business mailing address

AETHLON MEDICAL, INC. 11555 SORRENTO VALLEY ROAD
SAN DIEGO CA
92121
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-7800
  • Fax:
Mailing address:
  • Phone: 858-459-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD11364
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberN9888
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: