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General NPI Number Information
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NPI Number | 1487096947
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Entity Type | Individual
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Provider Name | LARISSA L. GARTH PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2719 S EL CAMINO REAL
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3354
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Country | US
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Telephone | 469-257-3500
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Fax | 949-569-1295
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Provider Business Mailing Address
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Address Line | 4132 TURNING LEAF DR
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City | NOLANVILLE
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State | TX
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Zip | 76559-0040
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Country | US
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Telephone | 469-257-3500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 63771
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10409
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-61580095
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA066148
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License Number State | PA
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