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General NPI Number Information
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NPI Number | 1861427247
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Entity Type | Individual
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Provider Name | DOMINGO A LARA MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1303 MCCULLOUGH AVE 138
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5609
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Country | US
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Telephone | 210-225-3330
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Fax | 210-497-8189
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Provider Business Mailing Address
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Address Line | 1303 MCCULLOUGH AVE 138
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5609
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Country | US
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Telephone | 210-225-3330
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Fax | 210-497-8189
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G6550
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License Number State | TX
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