Provider Demographics
NPI:1275959355
Name:LARA, ZORAIDA
Entity Type:Individual
Prefix:
First Name:ZORAIDA
Middle Name:
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:AC13 CALLE HAWAII
Mailing Address - Street 2:CAGUAS NORTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2215
Mailing Address - Country:US
Mailing Address - Phone:787-406-8505
Mailing Address - Fax:
Practice Address - Street 1:AC13 CALLE HAWAII
Practice Address - Street 2:CAGUAS NORTE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2215
Practice Address - Country:US
Practice Address - Phone:787-406-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003574103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling