Jordan Larsson
Student in an Organized Health Care Education/Training Program in Sacramento, CA. Individual provider (NPI-1).
NPI number1124882782
StatusActive
Last updated in NPPESFeb 13, 2024
Details
- NPI
- 1124882782
- Entity type
- Individual (NPI-1)
- Name
- Jordan Larsson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 13, 2024
- Certification date
- Feb 13, 2024
- Last updated
- Feb 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | CA | Yes |
Practice location
4610 X StSacramento, CA 95817-2200
Phone 209-717-9628
Mailing address
4610 X StSacramento, CA 95817-2200
Phone 209-717-9628
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