Healthcare Provider Details

I. General information

NPI: 1144408808
Provider Name (Legal Business Name): SANDRA KAY LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103-1513
US

IV. Provider business mailing address

1111 MARKET ST
SAN FRANCISCO CA
94103-1513
US

V. Phone/Fax

Practice location:
  • Phone: 415-863-3883
  • Fax: 415-863-7343
Mailing address:
  • Phone: 415-863-3883
  • Fax: 415-863-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: