MEDICARE: MS. DOLORES BEATRICE LARA M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMFT49989	CA

General Provider Information

NPI Number	:	1932232634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOLORES BEATRICE LARA M.S.

Provider Business Mailing Address
First Line	:	5727 REDMAN AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-1049
Country	:	US
Telephone Number	:	323-493-9130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2002
Country	:	US
Telephone Number	:	323-201-4154
Fax Number	:	323-201-4159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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