Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | G26396 | CA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G26396 | CA |
NPI | 1265503023 |
---|---|
Provider Name | Larry Michael Cousins |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G263960 | (05) | CA |