Provider Demographics
NPI:1518527480
Name:LAFARELLE, MARTHA IRMA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:IRMA
Last Name:LAFARELLE
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 1:14335 DESERT SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928
Mailing Address - Country:US
Mailing Address - Phone:915-249-9260
Mailing Address - Fax:
Practice Address - Street 1:14335 DESERT SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928
Practice Address - Country:US
Practice Address - Phone:915-249-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist