MEDICARE: GIOVANNI 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1881069441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIOVANNI LARA

Provider Business Mailing Address
First Line	:	50 BEALE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-1813
Country	:	US
Telephone Number	:	415-615-5640
Fax Number	:	415-615-5840

Provider Business Practice Location Address
First Line	:	50 BEALE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-1813
Country	:	US
Telephone Number	:	415-615-5640
Fax Number	:	415-615-5840

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

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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Directions to “ GIOVANNI LARA ” Practice Location

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