Active NPI
Paul A. Larez, PH.D.
- Clinical Psychologist
- Santa Ana, CA
National Provider Identifier
1104504851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY34102
- Practice address
- 1633 E 4TH St Ste 120
Santa Ana, CA 92701-5143 - Phone
- (714) 558-9266
- NPI assigned
- Jul 11, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY34102 | CA | Primary |
Addresses
Primary practice location
1633 E 4TH St Ste 120
Santa Ana, CA 92701-5143
Mailing address
1633 E 4TH St Ste 120
Santa Ana, CA 92701-5143
Phone (714) 558-9266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 15, 2023 through Dec 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34102 | CA | MD | Clinical Psychologist |
| 34102 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689033600000",
"number": "1104504851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1633 E 4TH ST STE 120",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927015143",
"telephone_number": "714-558-9266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1633 E 4TH ST STE 120",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927015143",
"telephone_number": "714-558-9266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAREZ",
"first_name": "PAUL",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-11",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY34102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.