MEDICARE: NOELLE LARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1619844149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELLE LARA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	866-611-1558

Provider Business Practice Location Address
First Line	:	3124 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1227
Country	:	US
Telephone Number	:	520-276-1274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	04/18/2026

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Directions to “ NOELLE LARA ” Practice Location

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