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Individual

PENNY LEE LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
12646 THORNBERG WAY, RANCHO CORDOVA, CA 95742-7839
(916) 238-6070
(916) 238-6070
Mailing address
1756 MAGENTA DR, ROSEVILLE, CA 95747-4915
(530) 300-8576

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01051820A
IN
207V00000X
Obstetrics & Gynecology Physician
55075
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
A93985
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
A93985
CA

Other

Enumeration date
10/17/2005
Last updated
06/15/2023
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