Larry Joseph Puentes, SUDRC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

12773 Issued in CA

Practice address

10936 Dale Ave
Stanton, CA 90680-2724

Phone

(714) 952-4032

Fax

(714) 952-4075

NPI assigned

Feb 10, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Roque Center, Inc

  • Substance Abuse Rehabilitation Facility
  • Stanton, CA
  • NPI 1689772170
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1407448533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10936 DALE AVE",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906802724",
            "telephone_number": "714-952-4032",
            "fax_number": "714-952-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10936 DALE AVE",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906802724",
            "telephone_number": "714-952-4032",
            "fax_number": "714-952-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUENTES",
        "first_name": "LARRY",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "SUDRC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-10",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "12773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ava Pollock
• Dianna Poolsawat
• Kash Powell
• Kathy Prakone
• Pueblo Medical Center Inc
• Eileen Ramezani
• Cynthia Ramirez Robles
• Ethan Ramirez
• Leonard Michael Ramirez
• Cynthia Ramos

• Addiction (Substance Use Disorder) Counselor in Stanton, CA
• Providers in Stanton, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.