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NPI Code Detail

MEDICARE: DR. JENNIFER P LARSON MD

MEDICARE: DR. JENNIFER P LARSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301075468MI
2207Q00000XFamily Medicine PhysicianMA229851MA
3207Q00000XFamily Medicine PhysicianC164590CA

General Provider Information

NPI Number : 1053301051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER P LARSON MD
Provider Business Mailing Address
First Line : 10874 KIMBALL PL
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1306
Country : US
Telephone Number : 810-531-0851
Fax Number :
Provider Business Practice Location Address
First Line : 451 W LINCOLN AVE STE 100
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-2912
Country : US
Telephone Number : 714-503-6550
Fax Number : 714-409-3075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 11/03/2023

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Directions to “ DR. JENNIFER P LARSON MD” Practice Location

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