Healthcare Provider Details

I. General information

NPI: 1417344128
Provider Name (Legal Business Name): ANNIE NGO LARROW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE NGO TAN M.D.

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 280
SAN DIEGO CA
92123-2752
US

IV. Provider business mailing address

7910 FROST ST STE 280
SAN DIEGO CA
92123-2752
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-4800
  • Fax: 858-496-4850
Mailing address:
  • Phone: 858-496-4800
  • Fax: 858-496-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: