Healthcare Provider Details

I. General information

NPI: 1578223574
Provider Name (Legal Business Name): LARA VASILJKA RIMASSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2021
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W TEAGUE AVE
FRESNO CA
93711-6072
US

IV. Provider business mailing address

414 W TEAGUE AVE
FRESNO CA
93711-6072
US

V. Phone/Fax

Practice location:
  • Phone: 559-691-3543
  • Fax: 765-737-2486
Mailing address:
  • Phone: 559-691-3543
  • Fax: 767-737-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: