Provider Demographics
NPI:1740581388
Name:LARSON, BRIA HEIDI (LAC)
Entity type:Individual
Prefix:MS
First Name:BRIA
Middle Name:HEIDI
Last Name:LARSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:25 JAVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4523
Mailing Address - Country:US
Mailing Address - Phone:415-810-1208
Mailing Address - Fax:415-358-4196
Practice Address - Street 1:3727 BUCHANAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-5410
Practice Address - Country:US
Practice Address - Phone:415-658-5871
Practice Address - Fax:415-358-4196
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC13947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist