Healthcare Provider Details

I. General information

NPI: 1700772795
Provider Name (Legal Business Name): CLAUDIA EVANOVA MELARA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N ARROWHEAD AVE
SAN BERNARDINO CA
92405-4116
US

IV. Provider business mailing address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1908
  • Fax: 909-972-0184
Mailing address:
  • Phone: 909-985-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06251102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: