Provider Demographics
NPI:1588966634
Name:LARA-CORMIER, BETTY (PA)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:LARA-CORMIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5197 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3272
Mailing Address - Country:US
Mailing Address - Phone:786-907-5827
Mailing Address - Fax:954-272-7179
Practice Address - Street 1:12781 MIRAMAR PKWY STE 206
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2908
Practice Address - Country:US
Practice Address - Phone:786-907-5827
Practice Address - Fax:954-272-7179
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist