Individual
DR. LARISSA ANNE GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1900 ROYALTY DR STE 180, POMONA, CA 91767-3046
(909) 784-3200
(909) 865-0730
Mailing address
1900 ROYALTY DR STE 180, POMONA, CA 91767-3046
(909) 784-3200
(909) 865-0730
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
A116676
CA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
A116676
CA
Other
Enumeration date
07/09/2009
Last updated
09/29/2015
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