Provider Demographics
NPI:1922979053
Name:EMPOWERED COMMUNITY MANAGEMENT
Entity type:Organization
Organization Name:EMPOWERED COMMUNITY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:805-680-2774
Mailing Address - Street 1:3911 CLEVELAND AVE # 33748
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3402
Mailing Address - Country:US
Mailing Address - Phone:805-680-2774
Mailing Address - Fax:
Practice Address - Street 1:3911 CLEVELAND AVE # 33748
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3402
Practice Address - Country:US
Practice Address - Phone:805-386-9712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management