Provider Demographics
NPI:1386508810
Name:LARUE, ZACHERY R (PPS)
Entity type:Individual
Prefix:
First Name:ZACHERY
Middle Name:R
Last Name:LARUE
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7961 TAMARIND AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2753
Mailing Address - Country:US
Mailing Address - Phone:909-357-5680
Mailing Address - Fax:909-357-5680
Practice Address - Street 1:7961 TAMARIND AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-2753
Practice Address - Country:US
Practice Address - Phone:909-357-5680
Practice Address - Fax:909-357-5680
Is Sole Proprietor?:No
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220208071101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool