Provider Demographics
NPI:1225862014
Name:AL-JAIBAJI, LARA MOLLY
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:MOLLY
Last Name:AL-JAIBAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1539
Mailing Address - Country:US
Mailing Address - Phone:213-598-0958
Mailing Address - Fax:
Practice Address - Street 1:8627 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-1539
Practice Address - Country:US
Practice Address - Phone:213-326-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker