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General NPI Number Information
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NPI Number | 1487334843
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Entity Type | Organization
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Legal Business Name | JONATHAN LARSON MD PC
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 10 N HIGH ST STE 222
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City | COLUMBUS
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State | OH
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Zip | 43215-3497
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Country | US
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Telephone | 949-484-9517
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Fax | 949-569-1295
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Provider Business Mailing Address
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Address Line | 2505 ANTHEM VILLAGE DRIVE SUITE E#162
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City | HENDERSON
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State | NV
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Zip | 89052-5529
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Country | US
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Telephone | 949-484-9517
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Fax | 949-569-1295
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOSHUA HOST
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Credential |
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Telephone | 949-484-9517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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