Healthcare Provider Details

I. General information

NPI: 1376032102
Provider Name (Legal Business Name): JOSE ANSELMO LARA JR. DNP, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 LOUETTA RD
HOUSTON TX
77070-3533
US

IV. Provider business mailing address

10850 LOUETTA RD
HOUSTON TX
77070-3533
US

V. Phone/Fax

Practice location:
  • Phone: 281-320-2338
  • Fax:
Mailing address:
  • Phone: 281-320-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: