Provider Demographics
NPI:1821439209
Name:LARA, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
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 1:26131 IMPERIAL HWY
Mailing Address - Street 2:SUITE C103
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:562-406-7385
Mailing Address - Fax:562-406-7393
Practice Address - Street 1:26131 IMPERIAL HWY
Practice Address - Street 2:SUITE C103
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-406-7385
Practice Address - Fax:562-406-7393
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator