| Doctor Name: | LARISSA ROLIM |
| NPI Number: | 1144678517 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM, MS |
| License Number: | 2199 |
| Business Practice Address: | 1120 Medical Plaza Dr Suite 180 Shenandoah, TX - 773803242 |
| Business Phone Number: | 2813649041 |
| Business Fax Number: | |
| Mailing Address: | 1120 Medical Plaza Dr, Suite 180 SHENANDOAH |
| State: | TX |
| Postal Code: | 773803242 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/26/2016 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 2199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |