Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G36130 | CA |
NPI | 1033438593 |
---|---|
Provider Name | Dr. Steven Richard Larson |
First Address | Folsom, CA 95630-8616 |
Second Address | Folsom, CA 95630-8616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 24/05/2010 |