Provider Demographics
NPI:1952067241
Name:LAREZ, SETH NIKKO
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:NIKKO
Last Name:LAREZ
Suffix:
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 1:333 VALLEYRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-3438
Mailing Address - Country:US
Mailing Address - Phone:831-214-5223
Mailing Address - Fax:
Practice Address - Street 1:2199 H DELA ROSA SR ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-3381
Practice Address - Country:US
Practice Address - Phone:831-223-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician