Provider Demographics
NPI:1497539472
Name:JARA, VICTORIA (LAC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JARA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 BERKMAN DR APT 213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2660
Mailing Address - Country:US
Mailing Address - Phone:850-294-3357
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMINO LA COSTA
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3930
Practice Address - Country:US
Practice Address - Phone:512-478-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist