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General NPI Number Information
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NPI Number | 1649840323
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Entity Type | Individual
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Provider Name | MONICO LARES JACOBO
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Gender | Male
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 2275 ARLINGTON DR
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1132
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Country | US
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Telephone | 510-317-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 8955 GOLF LINKS RD
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City | OAKLAND
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State | CA
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Zip | 94605-4124
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Country | US
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Telephone | 510-654-4004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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