Individual
LARRY MICHAEL COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8010 FROST ST, SUITE 300, SAN DIEGO, CA 92123-2778
(858) 939-6880
Mailing address
3860 CALLE FORTUNADA, STE #210, SAN DIEGO, CA 92123-4802
(858) 309-6303
(858) 309-6301
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
G26396
CA
207VM0101X
Maternal & Fetal Medicine Physician
Primary
G26396
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G263960
—
CA
Enumeration date
11/13/2006
Last updated
12/08/2011
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