Healthcare Provider Details

I. General information

NPI: 1114847134
Provider Name (Legal Business Name): MARIA PAOLA LARA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VILLA FONTANA,CALLE PARQUE CENTRAL 5V -10 2 PISO
CAROLINA PR
00983
US

IV. Provider business mailing address

URB. BAIROA PARK C4 PARQUE DE COLON
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 939-275-3516
  • Fax:
Mailing address:
  • Phone: 939-275-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8750
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: