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General NPI Number Information
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NPI Number | 1851653562
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Entity Type | Individual
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Provider Name | YURI LARA M.S. EDU
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Gender | Female
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Dates
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Enumeration Date | 06/10/2012
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Last Update Date | 06/10/2012
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Provider Practice Location Address
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Address Line | 382 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3181
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Country | US
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Telephone | 516-767-7216
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Fax |
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Provider Business Mailing Address
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Address Line | 83 2ND AVE APT 4A
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City | NEW YORK
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State | NY
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Zip | 10003-8665
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Country | US
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Telephone | 646-239-0045
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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