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General NPI Number Information
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NPI Number | 1538365309
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Entity Type | Individual
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Provider Name | LARISSA LACORTE MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 780 SHADOWRIDGE DR
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City | VISTA
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State | CA
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Zip | 92083-7986
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Country | US
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Telephone | 760-599-2523
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Fax | 760-599-2399
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Provider Business Mailing Address
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Address Line | 780 SHADOWRIDGE DR
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City | VISTA
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State | CA
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Zip | 92083-7986
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Country | US
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Telephone | 760-599-2523
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Fax | 760-599-2399
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 81297
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License Number State | AZ
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