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General NPI Number Information
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NPI Number | 1750583951
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Entity Type | Individual
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Provider Name | RAY JONATHAN LARA D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 2506 E VISTOSO COMMERCE LOOP STE 180
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City | ORO VALLEY
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State | AZ
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Zip | 85755-9114
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Country | US
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Telephone | 520-775-3333
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Fax | 520-775-3334
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Provider Business Mailing Address
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Address Line | 2506 E VISTOSO COMMERCE LOOP STE 180
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City | ORO VALLEY
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State | AZ
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Zip | 85755-9114
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Country | US
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Telephone | 520-775-3333
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Fax | 520-775-3334
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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 | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 005067
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License Number State | AZ
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