Provider Demographics
NPI:1568708246
Name:JUAN LARA
Entity Type:Organization
Organization Name:JUAN LARA
Other - Org Name:J & R MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-763-1175
Mailing Address - Street 1:1202 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5353
Mailing Address - Country:US
Mailing Address - Phone:956-568-1572
Mailing Address - Fax:956-568-4720
Practice Address - Street 1:1202 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5353
Practice Address - Country:US
Practice Address - Phone:956-763-1175
Practice Address - Fax:956-568-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies