Provider Demographics
NPI:1093598468
Name:LARA, HAIKANARUMI YAIS (LM, CPM, MSM)
Entity Type:Individual
Prefix:
First Name:HAIKANARUMI
Middle Name:YAIS
Last Name:LARA
Suffix:
Gender:F
Credentials:LM, CPM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 W 160TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2504
Mailing Address - Country:US
Mailing Address - Phone:773-757-7272
Mailing Address - Fax:
Practice Address - Street 1:4706 W 160TH ST
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2504
Practice Address - Country:US
Practice Address - Phone:773-757-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM710176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife