Provider Demographics
NPI:1366563538
Name:LARSEN, ROSE ANN (LAC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANN
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:4029 WESTERLY PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2318
Mailing Address - Country:US
Mailing Address - Phone:949-251-1109
Mailing Address - Fax:949-475-0165
Practice Address - Street 1:4029 WESTERLY PL
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2318
Practice Address - Country:US
Practice Address - Phone:949-251-1109
Practice Address - Fax:949-475-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC4579171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist