MEDICARE: LAARA ISRAHEL M.ED

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	106H00000X	Marriage & Family Therapist	LMFT50309	CA

General Provider Information

NPI Number	:	1710252085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAARA ISRAHEL M.ED

Provider Business Mailing Address
First Line	:	1162 15TH ST
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-1414
Country	:	US
Telephone Number	:	619-804-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 SUNSET DR STE E
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-4024
Country	:	US
Telephone Number	:	619-804-8747
Fax Number	:

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	04/12/2024

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