Healthcare Provider Details

I. General information

NPI: 1912989245
Provider Name (Legal Business Name): KEVIN DOYLE LARKIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MONTE ALTO RD
SANTA FE NM
87508-8865
US

IV. Provider business mailing address

109 MONTE ALTO RD
SANTA FE NM
87508-8865
US

V. Phone/Fax

Practice location:
  • Phone: 619-871-4364
  • Fax:
Mailing address:
  • Phone: 619-871-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT-706
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN423258
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2022-0209
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: