1417193145 NPI number — MELISSA E. LARSEN, M.D., INC.

Table of content: (NPI 1417193145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417193145 NPI number — MELISSA E. LARSEN, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISSA E. LARSEN, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417193145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93386-6309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-872-3311
Provider Business Mailing Address Fax Number:
661-872-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 FLOWER ST
Provider Second Line Business Practice Location Address:
OB/GYN DEPT
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93305-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-326-2236
Provider Business Practice Location Address Fax Number:
661-872-3366
Provider Enumeration Date:
12/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LARSEN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-326-2236

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G80218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G802180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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