Larissa Larsen Dermatology INC
Dermatology in Camarillo, CA. Organization (NPI-2).
NPI number1083239727
StatusActive
Last updated in NPPESNov 27, 2023
Details
- NPI
- 1083239727
- Entity type
- Organization (NPI-2)
- Legal business name
- Larissa Larsen Dermatology INC
- Organization subpart
- No
- Enumeration date
- Jun 9, 2020
- Certification date
- Jun 9, 2020
- Last updated
- Nov 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 261QM2500X | Clinic/Center, Medical Specialty | – | – |
Other names
- Camarillo Dermatology (Doing Business As)
Practice location
2460 N Ponderosa Dr Ste A117Camarillo, CA 93010-2468
Phone 805-430-0002 · Fax 805-389-1245
Mailing address
2460 N Ponderosa Dr Ste A117Camarillo, CA 93010-2468
Phone 805-430-0002
Authorized official
Larissa Nadia Larsen
Owner
8058072367
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