Healthcare Provider Details

I. General information

NPI: 1487016432
Provider Name (Legal Business Name): ERIC STANLEY LARSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 400
SANTA MONICA CA
90404-2139
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD. SUITE 200
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2663
  • Fax:
Mailing address:
  • Phone: 310-375-8700
  • Fax: 310-375-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA172788
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA172788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: