Healthcare Provider Details

I. General information

NPI: 1477364388
Provider Name (Legal Business Name): LARISA ZOLNEROVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UNIVERSITY BLVD BLDG A
ROUND ROCK TX
78665-1032
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-509-0200
  • Fax: 512-509-2229
Mailing address:
  • Phone: 800-994-0371
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18967
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: