MEDICARE: LARA EDINGER DO, A MEDICAL CORPORATION

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	2084N0400X	Neurology Physician	20A14194	CA
2	208VP0014X	Interventional Pain Medicine Physician	20A14194	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679020705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARA EDINGER DO, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD STE 1109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4005
Country	:	US
Telephone Number	:	424-273-4662
Fax Number	:	310-861-1358

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD STE 1109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4005
Country	:	US
Telephone Number	:	424-273-4662
Fax Number	:	310-861-1358

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LARA KRISTIN EDINGER
Credential	:
Telephone Number	:	424-273-4662

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	12/11/2025

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