Provider Demographics
NPI:1760618821
Name:LARA, MELISSA ELENA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ELENA
Last Name:LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11463 BEATY AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-7924
Mailing Address - Country:US
Mailing Address - Phone:714-254-5612
Mailing Address - Fax:
Practice Address - Street 1:11463 BEATY AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-7924
Practice Address - Country:US
Practice Address - Phone:714-254-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist