MEDICARE: LARISA A TARASOVA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1679351498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISA A TARASOVA

Provider Business Mailing Address
First Line	:	9061 ALPINE PEAKS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7819
Country	:	US
Telephone Number	:	702-502-4754
Fax Number	:

Provider Business Practice Location Address
First Line	:	9061 ALPINE PEAKS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7819
Country	:	US
Telephone Number	:	702-502-4754
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ LARISA A TARASOVA ” Practice Location

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