Provider Demographics
NPI:1932920378
Name:LARA, DINA M (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:M
Last Name:LARA
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:MRS
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL PSYCHOLOGIST
Mailing Address - Street 1:4210 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6337
Mailing Address - Country:US
Mailing Address - Phone:510-657-2350
Mailing Address - Fax:
Practice Address - Street 1:HARVEY GREEN ELEMENTARY
Practice Address - Street 2:42875 GATEWOOD STREET
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-656-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240027151103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool