Provider Demographics
NPI:1265229553
Name:COAST PSYCHIATRY MEDICAL GROUP
Entity type:Organization
Organization Name:COAST PSYCHIATRY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-380-7194
Mailing Address - Street 1:555 BRYANT ST STE 378
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1704
Mailing Address - Country:US
Mailing Address - Phone:650-380-7194
Mailing Address - Fax:650-282-4459
Practice Address - Street 1:1000 FREMONT AVE STE 250A
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6058
Practice Address - Country:US
Practice Address - Phone:650-629-7532
Practice Address - Fax:650-282-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty