Healthcare Provider Details

I. General information

NPI: 1467797365
Provider Name (Legal Business Name): RAUL N LARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 NATIVIDAD RD
SALINAS CA
93906-3138
US

IV. Provider business mailing address

747 52ND ST RM 245
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 831-754-4444
  • Fax:
Mailing address:
  • Phone: 714-262-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA137807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: