Provider Demographics
NPI:1407372592
Name:LORA, YAZMIN S
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:S
Last Name:LORA
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 1:4323 165TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3255
Mailing Address - Country:US
Mailing Address - Phone:347-239-2932
Mailing Address - Fax:
Practice Address - Street 1:4323 165TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3255
Practice Address - Country:US
Practice Address - Phone:347-239-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist