Basic Information
| Provider Information | |||||||||
| NPI: | 1295168664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARIS | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | FIMBRES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 982 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155978000 | ||||||||
| FaxNumber: | 4155978004 | ||||||||
| Practice Location | |||||||||
| Address1: | 982 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155978000 | ||||||||
| FaxNumber: | 4155978004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | ASW74293 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | 74293 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.