Provider Demographics
NPI:1316587892
Name:LARA, DESIREE B
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:B
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 1:73 MARKET ST STE 376
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7619
Mailing Address - Country:US
Mailing Address - Phone:914-226-3439
Mailing Address - Fax:
Practice Address - Street 1:73 MARKET ST RIDGE HILL
Practice Address - Street 2:SUITE 376
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1071
Practice Address - Country:US
Practice Address - Phone:914-226-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator