Provider Demographics
NPI:1740764836
Name:ALI, LARAIB
Entity Type:Individual
Prefix:
First Name:LARAIB
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FOX HOLW
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5494
Mailing Address - Country:US
Mailing Address - Phone:510-396-3512
Mailing Address - Fax:
Practice Address - Street 1:275 BAKER ST STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4566
Practice Address - Country:US
Practice Address - Phone:714-361-6760
Practice Address - Fax:714-361-6768
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW853521041C0700X
CALCSW1026141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical