Provider Demographics
NPI:1003800681
Name:AUDA, LARRY RENE (DC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:RENE
Last Name:AUDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 S VICTORIA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9078
Mailing Address - Country:US
Mailing Address - Phone:805-644-3629
Mailing Address - Fax:805-644-8720
Practice Address - Street 1:789 S VICTORIA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9078
Practice Address - Country:US
Practice Address - Phone:805-644-3629
Practice Address - Fax:805-644-8720
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20503Medicare ID - Type Unspecified