Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC26758 | CA |
NPI | 1174537757 |
---|---|
Provider Name | Dr. John Christopher Larson |
First Address | Rancho Cucamonga, CA 91701-9265 |
Second Address | Rancho Cucamonga, CA 91701-9265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |