Healthcare Provider Details

I. General information

NPI: 1881213072
Provider Name (Legal Business Name): OLIVIA DANIELLE LARKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N DOUGLAS BLVD, #210
EL SEGUNDO CA
90245
US

IV. Provider business mailing address

483 N DOUGLAS BLVD, #210
EL SEGUNDO CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 310-653-6860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101273288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: