Individual
LARRY ALLEN JEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3230 KERNER BLVD, SAN RAFAEL, CA 94901-4840
(415) 847-3209
Mailing address
36D OLIVA DR, NOVATO, CA 94947-2123
(415) 450-0105
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
CA
Other
Enumeration date
07/18/2013
Last updated
04/12/2023
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