Healthcare Provider Details

I. General information

NPI: 1992636195
Provider Name (Legal Business Name): DANIELLE NICOLE LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12820 BESS AVE
BALDWIN PARK CA
91706-4546
US

IV. Provider business mailing address

337 W 2ND ST
SAN DIMAS CA
91773-2029
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-4019
  • Fax:
Mailing address:
  • Phone: 626-523-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP37942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: