Healthcare Provider Details

I. General information

NPI: 1164496030
Provider Name (Legal Business Name): CHARLES STEVEN LARSEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 130
SCOTTSDALE AZ
85251-5649
US

IV. Provider business mailing address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-5000
  • Fax: 480-425-5033
Mailing address:
  • Phone: 602-521-6200
  • Fax: 623-842-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3179
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3179
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3179
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: