Healthcare Provider Details

I. General information

NPI: 1184945206
Provider Name (Legal Business Name): REBECCA F LARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE STE 330
AURORA IL
60504-5897
US

IV. Provider business mailing address

2020 OGDEN AVE STE 330
AURORA IL
60504-5897
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 630-978-4850
  • Fax: 630-978-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number255309
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number245248
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-148815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: