Provider Demographics
NPI:1194825794
Name:LARA, RICHARD O (CSFA/CST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:LARA
Suffix:
Gender:M
Credentials:CSFA/CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 HILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2357
Mailing Address - Country:US
Mailing Address - Phone:210-997-2188
Mailing Address - Fax:210-682-9967
Practice Address - Street 1:6442 HILL CREEK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2357
Practice Address - Country:US
Practice Address - Phone:210-997-2188
Practice Address - Fax:210-682-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101961246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant