Provider Demographics
NPI:1568916500
Name:LARIOS, RICHARD (CAADEII)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LARIOS
Suffix:
Gender:M
Credentials:CAADEII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4668
Mailing Address - Country:US
Mailing Address - Phone:831-462-1060
Mailing Address - Fax:831-423-4269
Practice Address - Street 1:284 PENNSYLVANIA DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3768
Practice Address - Country:US
Practice Address - Phone:831-319-4200
Practice Address - Fax:831-423-4269
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8075-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578630183Medicaid