Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP131769 | TX |
NPI | 1225489420 |
---|---|
Provider Name | Larissa Losolla |
First Address | Lubbock, TX 79414-3708 |
Second Address | Lubbock, TX 79415-3364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 29/11/2016 |