Healthcare Provider Details

I. General information

NPI: 1871409276
Provider Name (Legal Business Name): ABRIL B LARA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N MAIN STREET
SAN LUIS AZ
85349
US

IV. Provider business mailing address

PO BOX 6870
SAN LUIS AZ
85349-6802
US

V. Phone/Fax

Practice location:
  • Phone: 928-627-6960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5077043
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: