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General NPI Number Information
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NPI Number | 1588791990
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Entity Type | Individual
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Provider Name | LARA LAINEZ
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1456 S SEMORAN BLVD
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City | ORLANDO
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State | FL
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Zip | 32807-2918
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Country | US
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Telephone | 407-380-5050
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Fax | 407-380-3806
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Provider Business Mailing Address
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Address Line | 5208 LAKE MARGARET DR APT 1301
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City | ORLANDO
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State | FL
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Zip | 32812-6144
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Country | US
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Telephone | 407-883-4423
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 42327
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License Number State | FL
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