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General NPI Number Information
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NPI Number | 1427843895
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Entity Type | Individual
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Provider Name | LARA V VIDAL ZALAZAR
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Gender | Female
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 7441 BARTLETT ST NE STE 1C
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5916
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Country | US
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Telephone | 505-990-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 11009 CORDOVA AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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