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General NPI Number Information
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NPI Number | 1699740324
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Entity Type | Individual
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Provider Name | CARLOS MANRIQUE DE LARA M.D., F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 2518 W TRENTON RD
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City | EDINBURG
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State | TX
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Zip | 78539-8070
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Country | US
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Telephone | 956-661-9000
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Fax | 956-686-7833
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Provider Business Mailing Address
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Address Line | PO BOX 2706
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City | MCALLEN
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State | TX
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Zip | 78502-2706
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Country | US
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Telephone | 956-661-9000
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Fax | 956-686-7833
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | K3794
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License Number State | TX
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