Provider Demographics
NPI:1386727774
Name:LARA, HENRY (AP)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:LARA
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6576
Mailing Address - Country:US
Mailing Address - Phone:239-261-6355
Mailing Address - Fax:239-263-3222
Practice Address - Street 1:350 5TH AVE S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6576
Practice Address - Country:US
Practice Address - Phone:239-261-6355
Practice Address - Fax:239-263-3222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist