MEDICARE: LARA HEATHER SPENCE MD

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	2086S0102X	Surgical Critical Care Physician	A133366	CA
2	208600000X	Surgery Physician	A133366	CA

General Provider Information

NPI Number	:	1942505045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA HEATHER SPENCE MD

Provider Business Mailing Address
First Line	:	FILE 57326
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-7326
Country	:	US
Telephone Number	:	800-926-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	UCSD TRAUMA CRITICAL CARE FELLOWSHIP
Second Line	:	200 WEST ARBOR DR #8896
City	:	SAN DIEGO
State	:	CA
Zip	:	92103
Country	:	US
Telephone Number	:	619-543-7107
Fax Number	:

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	06/24/2025

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Directions to “ LARA HEATHER SPENCE MD” Practice Location

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