Healthcare Provider Details

I. General information

NPI: 1841106739
Provider Name (Legal Business Name): DIEGO JOEL LARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E SAN JOAQUIN ST STE 101
SALINAS CA
93901-2946
US

IV. Provider business mailing address

30 E SAN JOAQUIN ST STE 101
SALINAS CA
93901-2946
US

V. Phone/Fax

Practice location:
  • Phone: 831-808-3348
  • Fax:
Mailing address:
  • Phone: 831-808-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number99-3070742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: