NPIMap

Organization Active NPI

Larissa Larsen Dermatology Inc

  • Dermatology Physician
  • Camarillo, CA
National Provider Identifier
1083239727
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LARISSA LARSEN DERMATOLOGY INC
Practice address
2460 N Ponderosa Dr Ste A117
Camarillo, CA 93010-2468
Phone
(805) 430-0002
Fax
(805) 389-1245
NPI assigned
Jun 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larissa Nadia Larsen, MDNPI 1063733426
Title
Owner
Phone
(805) 807-2367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

2460 N Ponderosa Dr Ste A117
Camarillo, CA 93010-2468

Mailing address

2460 N Ponderosa Dr Ste A117
Camarillo, CA 93010-2468
Phone (805) 430-0002

Other names 1

  • Camarillo Dermatology Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.google.com/search?q=pacifica+center+for+dermatology&rlz=1C1GCEV_enUS821US821&oq=pacifica Pacifica Dermatology

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1083239727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 N PONDEROSA DR STE A117",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930102468",
            "telephone_number": "805-430-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 N PONDEROSA DR STE A117",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930102468",
            "telephone_number": "805-430-0002",
            "fax_number": "805-389-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARISSA LARSEN DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_middle_name": "NADIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-807-2367",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.google.com/search?q=pacifica+center+for+dermatology&rlz=1C1GCEV_enUS821US821&oq=pacifica",
            "affiliation": "Y",
            "affiliationName": "Pacifica Dermatology",
            "address_1": "2460 N Ponderosa Dr Ste A117",
            "city": "Camarillo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "930102468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Camarillo Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camarillo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.