Provider Demographics
NPI:1144409616
Name:ALLAN I LARNER MD, INC.
Entity Type:Organization
Organization Name:ALLAN I LARNER MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:LARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-468-4656
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003
Mailing Address - Country:US
Mailing Address - Phone:760-468-4656
Mailing Address - Fax:760-723-3223
Practice Address - Street 1:921 S BEACON ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3740
Practice Address - Country:US
Practice Address - Phone:760-468-4656
Practice Address - Fax:760-723-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A285960Medicaid
CAW099Medicare PIN
CA00A285960Medicaid