Basic Information
| Provider Information | |||||||||
| NPI: | 1467678375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALARCON | ||||||||
| FirstName: | ORLANDO | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DRUG AND ALCOHOL CER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4871 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954024871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073605070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 634 PRESSLEY ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954045526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075736955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1377 | 01 | CA | COUNTY MENTAL HEALTH # | OTHER |