Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 681341 | CA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 681341 | CA |
NPI | 1104072719 |
---|---|
Provider Name | Mrs. Larisa Zabokritskaya |
First Address | Marina Del Rey, CA 90292-7071 |
Second Address | Marina Del Rey, CA 90292-7071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 14/08/2008 |