Provider Demographics
NPI:1689910127
Name:LARA, HONEL
Entity Type:Individual
Prefix:
First Name:HONEL
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HONEL
Other - Middle Name:
Other - Last Name:RONGCAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1714 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3124
Mailing Address - Country:US
Mailing Address - Phone:714-673-5253
Mailing Address - Fax:
Practice Address - Street 1:1714 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3124
Practice Address - Country:US
Practice Address - Phone:714-673-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3629947172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver