Provider Demographics
NPI:1508378563
Name:SABERON, LARA ELAINE AVENGOZA (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LARA ELAINE
Middle Name:AVENGOZA
Last Name:SABERON
Suffix:
Gender:F
Credentials:MSN, FNP-C
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4301
Mailing Address - Country:US
Mailing Address - Phone:510-643-5808
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-643-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342276363LF0000X
CA95018183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily