Individual
BRENT K. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 SAN PABLO STREET, PATHOLOGY LAB, LOS ANGELES, CA 90033-5313
(323) 442-2588
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-2588
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
20A12618
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A12618
LICENSE
CA
Enumeration date
03/06/2014
Last updated
09/02/2016
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