Healthcare Provider Details

I. General information

NPI: 1457257180
Provider Name (Legal Business Name): NATALIE LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2026
Last Update Date: 10/19/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 SLATER AVE
FOUNTAIN VALLEY CA
92708-4749
US

IV. Provider business mailing address

10055 SLATER AVE
FOUNTAIN VALLEY CA
92708-4749
US

V. Phone/Fax

Practice location:
  • Phone: 714-423-9982
  • Fax:
Mailing address:
  • Phone: 714-843-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250056870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: