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NPI Code Detail

MEDICARE: MS. REBECCA RAQUEL LARSON PA-C

MEDICARE: MS. REBECCA RAQUEL LARSON PA-C
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1114885050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA RAQUEL LARSON PA-C
Provider Business Mailing Address
First Line : 4331 N PLACITA CAMALEON
Second Line :
City : TUCSON
State : AZ
Zip : 85718-7475
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1625 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85719-4330
Country : US
Telephone Number : 520-694-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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