Individual
DR. DEREK THOMAS LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-7478
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-7478
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
0102203897
VA
208D00000X
General Practice Physician
0102203897
VA
Other
Enumeration date
02/13/2013
Last updated
08/14/2023
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