Provider Demographics
NPI:1699250910
Name:LARA, ELIZABETH MICHELLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MICHELLE
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 1:9149 SOMERSET BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3446
Mailing Address - Country:US
Mailing Address - Phone:562-658-7092
Mailing Address - Fax:
Practice Address - Street 1:9149 SOMERSET BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3446
Practice Address - Country:US
Practice Address - Phone:562-658-7092
Practice Address - Fax:562-658-7092
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker