Healthcare Provider Details

I. General information

NPI: 1679841290
Provider Name (Legal Business Name): MS. JANA CAI LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4513
US

IV. Provider business mailing address

10710 EL CAMINO REAL APARTMENT 1
ATASCADERO CA
93422
US

V. Phone/Fax

Practice location:
  • Phone: 805-788-2060
  • Fax:
Mailing address:
  • Phone: 805-801-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: