Provider Demographics
NPI:1043434046
Name:LARA, VERONICA (BA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E SAN JOAQUIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2946
Mailing Address - Country:US
Mailing Address - Phone:831-249-1308
Mailing Address - Fax:831-998-8704
Practice Address - Street 1:43 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3123
Practice Address - Country:US
Practice Address - Phone:831-755-7870
Practice Address - Fax:831-755-7875
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 175T00000X
CA275801753171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer Specialist