Provider Demographics
NPI:1033767280
Name:LARA, SARAH JULIE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JULIE
Last Name:LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18947 SANTA MARIA AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3138
Mailing Address - Country:US
Mailing Address - Phone:925-895-9860
Mailing Address - Fax:
Practice Address - Street 1:18947 SANTA MARIA AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-3138
Practice Address - Country:US
Practice Address - Phone:925-895-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16807011OtherKAISER