Healthcare Provider Details

I. General information

NPI: 1508612722
Provider Name (Legal Business Name): WILLIAM LARA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 NEIL RD
RENO NV
89502-6808
US

IV. Provider business mailing address

680 S ROCK BLVD
RENO NV
89502-4113
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-6300
  • Fax: 775-348-3896
Mailing address:
  • Phone: 775-329-6300
  • Fax: 775-348-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3299
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: