Healthcare Provider Details

I. General information

NPI: 1437084068
Provider Name (Legal Business Name): LARA JEAN CARLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 COUNTRY CLUB DR
CALIMESA CA
92320-1165
US

IV. Provider business mailing address

209 COUNTRY CLUB DR
CALIMESA CA
92320-1165
US

V. Phone/Fax

Practice location:
  • Phone: 909-801-9145
  • Fax:
Mailing address:
  • Phone: 909-801-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: