Provider Demographics
NPI:1053645887
Name:EDINGER, LARA KRISTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:KRISTIN
Last Name:EDINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD STE 1109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4005
Mailing Address - Country:US
Mailing Address - Phone:484-343-8134
Mailing Address - Fax:310-861-1358
Practice Address - Street 1:10921 WILSHIRE BLVD STE 1109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4005
Practice Address - Country:US
Practice Address - Phone:424-273-4662
Practice Address - Fax:310-861-1358
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A141942084N0400X, 208VP0014X, 2084P2900X
PAOTO129372084N0400X
WAOP60453782084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB266766Medicaid