Healthcare Provider Details

I. General information

NPI: 1316200496
Provider Name (Legal Business Name): JORDAN ELIZABETH LARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JORDAN ELIZABETH SCHMIDT

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD., PSSB 2100
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2315 STOCKTON BLVD., PSSB 2100
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8571
  • Fax: 916-734-7950
Mailing address:
  • Phone: 916-734-8571
  • Fax: 916-734-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60528083
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: