Provider Demographics
NPI:1235259961
Name:LARCO, ANA R
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:R
Last Name:LARCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANA
Other - Middle Name:R
Other - Last Name:ENAMORADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19330 SAN LEANDRO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2110
Mailing Address - Country:US
Mailing Address - Phone:661-259-9439
Mailing Address - Fax:
Practice Address - Street 1:21545 CENTRE POINT PARKWAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:90010-2804
Practice Address - Country:US
Practice Address - Phone:661-259-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist