Healthcare Provider Details

I. General information

NPI: 1306007042
Provider Name (Legal Business Name): ISSADORA LARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ISSADORA ARAUJO M.D.

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-2020
  • Fax:
Mailing address:
  • Phone: 760-357-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA109540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: