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NPI Code Detail

MEDICARE: DR. IONE VILDRIA LARA MD

MEDICARE:  DR. IONE VILDRIA LARA  MD
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
12084P0804XChild & Adolescent Psychiatry PhysicianME41287FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130574OTHERFLBCBS OF FL

General Provider Information

NPI Number : 1992809354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IONE VILDRIA LARA MD
Provider Business Mailing Address
First Line : 2212 E HENRY AVENUE
Second Line :
City : TAMPA
State : FL
Zip : 33610
Country : US
Telephone Number : 813-272-2882
Fax Number : 813-272-3198
Provider Business Practice Location Address
First Line : 2212 E HENRY AVENUE
Second Line :
City : TAMPA
State : FL
Zip : 33610
Country : US
Telephone Number : 813-272-2882
Fax Number : 813-272-3198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 07/08/2007

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Directions to “ DR. IONE VILDRIA LARA MD” Practice Location

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