Healthcare Provider Details

I. General information

NPI: 1982955399
Provider Name (Legal Business Name): ERIC MOWATT-LARSSEN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 PACIFIC ST STE B
MONTEREY CA
93940-4400
US

IV. Provider business mailing address

977 PACIFIC ST STE B
MONTEREY CA
93940-4400
US

V. Phone/Fax

Practice location:
  • Phone: 831-646-8346
  • Fax: 831-646-5261
Mailing address:
  • Phone: 831-646-8346
  • Fax: 831-646-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberC55209
License Number StateCA

VIII. Authorized Official

Name: DR. ERIC MOWATT-LARSSEN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 831-646-8346