Healthcare Provider Details

I. General information

NPI: 1881069441
Provider Name (Legal Business Name): GIOVANNI LARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BEALE ST
SAN FRANCISCO CA
94105-1813
US

IV. Provider business mailing address

50 BEALE ST
SAN FRANCISCO CA
94105-1813
US

V. Phone/Fax

Practice location:
  • Phone: 415-615-5640
  • Fax: 415-615-5840
Mailing address:
  • Phone: 415-615-5640
  • Fax: 415-615-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: