=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417193145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA E. LARSEN, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2008
-----------------------------------------------------
Last Update Date | 12/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1830 FLOWER ST OB/GYN DEPT
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93305-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-326-2236
-----------------------------------------------------
Fax | 661-872-3366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6309
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93386-6309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-872-3311
-----------------------------------------------------
Fax | 661-872-3366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MELISSA ELLEN LARSEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 661-326-2236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | G80218
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------