Provider Demographics
NPI:1215059050
Name:ARAGON, LARRY THEODORE (CADAC II, ICADC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:THEODORE
Last Name:ARAGON
Suffix:
Gender:M
Credentials:CADAC II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25612 BARTON RD # 286
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:909-478-2359
Mailing Address - Fax:
Practice Address - Street 1:25612 BARTON RD # 286
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3110
Practice Address - Country:US
Practice Address - Phone:909-478-2359
Practice Address - Fax:909-748-6424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)