Healthcare Provider Details

I. General information

NPI: 1841871969
Provider Name (Legal Business Name): VICTORIA LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 301
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

1530 CELEBRATION BLVD STE 301
CELEBRATION FL
34747-5165
US

V. Phone/Fax

Practice location:
  • Phone: 866-595-5113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: