Most Relevant Information
Provider Data
| NPI Number: | 1003070319 |
| Provider Name: | LARISA SURENOVNA DZHAVAKOVA M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/16/2008 |
| Last Updated: | 07/16/2008 |
Provider Practice Location
1701 A GRANT AVE
PHILADELPHIA
PA
191153160
Practice Location Phone/Fax
| Phone: | 2154643838 |
| Fax: | 2154643899 |
Provider Mailing Location
1701 A GRANT AVE
PHILADELPHIA
PA
191153160
Provider Mailing Phone/Fax
| Phone: | 2154643838 |
| Fax: | 2154643899 |