Individual
BRENT RAYMOND LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1393 SANTA RITA RD, SUITE F, PLEASANTON, CA 94566-5665
(925) 462-2334
(925) 462-2335
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 347-1012
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A63652
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A636520
—
CA
Enumeration date
01/24/2007
Last updated
11/17/2008
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