Healthcare Provider Details

I. General information

NPI: 1629989660
Provider Name (Legal Business Name): SOPHIA JULIANA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

IV. Provider business mailing address

1601 RIDGECREST ST APT A
MONTEREY PARK CA
91754-4363
US

V. Phone/Fax

Practice location:
  • Phone: 213-285-4260
  • Fax: 213-266-8177
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: