Provider Demographics
NPI:1285372318
Name:LARA, ORQUIDEA
Entity type:Individual
Prefix:
First Name:ORQUIDEA
Middle Name:
Last Name:LARA
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 1:4050 NW 135TH ST APT 10-18
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-4644
Mailing Address - Country:US
Mailing Address - Phone:305-519-6369
Mailing Address - Fax:
Practice Address - Street 1:4050 NW 135TH ST APT 10-18
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-4644
Practice Address - Country:US
Practice Address - Phone:305-519-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty