Provider Demographics
NPI:1114283322
Name:LARSSON, INGRID LINNEA (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:LINNEA
Last Name:LARSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3717
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3304
Practice Address - Country:US
Practice Address - Phone:510-204-8166
Practice Address - Fax:925-254-0687
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA130729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine