Individual
COREY B. LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30745 PACIFIC COAST HWY # 439, MALIBU, CA 90265-3647
(310) 874-0440
Mailing address
11999 SAN VICENTE BLVD STE 440, LOS ANGELES, CA 90049-5042
(310) 471-5852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G21579
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G215790
—
CA
Enumeration date
11/08/2007
Last updated
01/31/2014
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