Provider Demographics
NPI:1629216783
Name:LA BARE, CHLOE JULIE (CMT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:JULIE
Last Name:LA BARE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3606
Mailing Address - Country:US
Mailing Address - Phone:415-564-7000
Mailing Address - Fax:
Practice Address - Street 1:861 40TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3316
Practice Address - Country:US
Practice Address - Phone:415-724-6958
Practice Address - Fax:415-724-6959
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist