Healthcare Provider Details

I. General information

NPI: 1992718969
Provider Name (Legal Business Name): PHYLLIS M LARKIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 PACIFIC AVE UNIT H4
COSTA MESA CA
92627-3988
US

IV. Provider business mailing address

2175 PACIFIC AVE UNIT H4
COSTA MESA CA
92627-3988
US

V. Phone/Fax

Practice location:
  • Phone: 714-606-6401
  • Fax:
Mailing address:
  • Phone: 714-606-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: