Provider Demographics
NPI:1891820478
Name:ALFARO, ROBERTO EDMUNDO (CATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:EDMUNDO
Last Name:ALFARO
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LUCKY ST
Mailing Address - Street 2:APT. B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4122
Mailing Address - Country:US
Mailing Address - Phone:415-550-9255
Mailing Address - Fax:
Practice Address - Street 1:820 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1737
Practice Address - Country:US
Practice Address - Phone:415-826-6767
Practice Address - Fax:415-826-6774
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030743101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)