Individual
JENNIFER LEEVONNE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8825 AERO DR STE 305, SAN DIEGO, CA 92123-2270
(858) 571-1964
Mailing address
8825 AERO DR STE 305, SAN DIEGO, CA 92123-2270
(858) 571-1964
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
A130546
CA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
A130546
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2012
Last updated
09/13/2024
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