Provider Demographics
NPI:1659050789
Name:LARA MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:LARA MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEGRIN MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-239-2753
Mailing Address - Street 1:8410 W FLAGLER ST STE 208B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2000
Mailing Address - Country:US
Mailing Address - Phone:786-239-2753
Mailing Address - Fax:
Practice Address - Street 1:8410 W FLAGLER ST STE 208B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2000
Practice Address - Country:US
Practice Address - Phone:786-239-2753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty