Individual
DR. DONALD W. LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 SAN PABLO ST, STE 3800, LOS ANGELES, CA 90033-5310
(323) 442-5720
(323) 442-7543
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5720
(323) 442-7543
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
G58082
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G580820
—
CA
01
—
BR640Z
PTAN
—
Enumeration date
06/16/2006
Last updated
01/10/2018
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