Provider Demographics
NPI:1639948094
Name:JOHN LARSON PLASTIC SURGERY, INC
Entity Type:Organization
Organization Name:JOHN LARSON PLASTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-690-9084
Mailing Address - Street 1:30262 CROWN VALLEY PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2364
Mailing Address - Country:US
Mailing Address - Phone:949-688-7733
Mailing Address - Fax:949-688-7733
Practice Address - Street 1:250 NEWPORT CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7517
Practice Address - Country:US
Practice Address - Phone:949-688-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty