Healthcare Provider Details

I. General information

NPI: 1225862014
Provider Name (Legal Business Name): LARA MOLLY AL-JAIBAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8627 JUNIPER ST
LOS ANGELES CA
90002-1539
US

IV. Provider business mailing address

8627 JUNIPER ST
LOS ANGELES CA
90002-1539
US

V. Phone/Fax

Practice location:
  • Phone: 213-326-0732
  • Fax:
Mailing address:
  • Phone: 213-598-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: