Provider Demographics
NPI:1568043867
Name:LARA, LIZETE (MD)
Entity Type:Individual
Prefix:
First Name:LIZETE
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 ENGLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9777
Mailing Address - Country:US
Mailing Address - Phone:915-242-9378
Mailing Address - Fax:
Practice Address - Street 1:5001 EL PASO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2827
Practice Address - Country:US
Practice Address - Phone:915-215-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program