MEDICARE: LARISSA MARKEVICH NP

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	363L00000X	Nurse Practitioner	13502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN502860	OTHER	CA	RN CERTIFICATE
2	13502	OTHER	CA	CALIFORNIA LISENCE

General Provider Information

NPI Number	:	1841417573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA MARKEVICH NP

Provider Business Mailing Address
First Line	:	2170 CENTURY PARK E
Second Line	:	SUITE 1506
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2243
Country	:	US
Telephone Number	:	213-590-3480
Fax Number	:	310-286-1090

Provider Business Practice Location Address
First Line	:	2170 CENTURY PARK E
Second Line	:	SUITE 1506
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2243
Country	:	US
Telephone Number	:	213-590-3480
Fax Number	:	310-286-1090

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	11/22/2013

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