Provider Demographics
NPI:1710165733
Name:LORETTA LARY
Entity Type:Organization
Organization Name:LORETTA LARY
Other - Org Name:PRINCE;S MEDICAL BILLING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-334-9724
Mailing Address - Street 1:391 SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2040
Mailing Address - Country:US
Mailing Address - Phone:707-334-9724
Mailing Address - Fax:707-644-4219
Practice Address - Street 1:391 SAWYER ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2040
Practice Address - Country:US
Practice Address - Phone:707-334-9724
Practice Address - Fax:707-644-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty