Healthcare Provider Details

I. General information

NPI: 1730138140
Provider Name (Legal Business Name): DEBORAH COMPEL LARSON RN,MN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HUNTINGTON MEMORIAL HOSPITAL 100 W CALIFORNIA BLVD
PASADENA CA
91109-7013
US

IV. Provider business mailing address

6551 W 85TH PL
LOS ANGELES CA
90045-2819
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-8771
  • Fax:
Mailing address:
  • Phone: 310-649-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number355797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: