MEDICARE: VICTORIA LARSEN

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
1	171M00000X	Case Manager/Care Coordinator
2	106H00000X	Marriage & Family Therapist	133902	CA

General Provider Information

NPI Number	:	1093465304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LARSEN

Provider Business Mailing Address
First Line	:	4200 GRANDVIEW DR
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93551-5212
Country	:	US
Telephone Number	:	747-288-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 DENA WAY
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-2551
Country	:	US
Telephone Number	:	805-361-7940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	07/25/2025

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Directions to “ VICTORIA LARSEN ” Practice Location

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