Healthcare Provider Details

I. General information

NPI: 1548186315
Provider Name (Legal Business Name): NATASHA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 E ADOBE ST
MESA AZ
85205-5391
US

IV. Provider business mailing address

4840 E ADOBE ST
MESA AZ
85205-5391
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-7850
  • Fax:
Mailing address:
  • Phone: 480-472-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: