MEDICARE: MS. LARISA KARAZHOVA FNP

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	207Q00000X	Family Medicine Physician	NP20335	CA
2	363LF0000X	Family Nurse Practitioner	20335	CA

General Provider Information

NPI Number	:	1144520388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARISA KARAZHOVA FNP

Provider Business Mailing Address
First Line	:	5038 LAUREL CANYON BLVD APT 106
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-769-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	5038 LAUREL CANYON BLVD APT 106
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-769-5462
Fax Number	:

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

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	04/17/2012

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