Provider Demographics
NPI:1700410297
Name:LINARES, ALFREDO EDUARDO JR
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:EDUARDO
Last Name:LINARES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WHIPPLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2109
Mailing Address - Country:US
Mailing Address - Phone:909-301-1762
Mailing Address - Fax:
Practice Address - Street 1:205 WHIPPLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2109
Practice Address - Country:US
Practice Address - Phone:909-301-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty