Provider Demographics
NPI:1851590061
Name:BUSSEY, LARA STRENG (DO)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:STRENG
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ASHLEY
Other - Last Name:STRENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1720 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3315
Mailing Address - Country:US
Mailing Address - Phone:530-898-0504
Mailing Address - Fax:530-898-9647
Practice Address - Street 1:1720 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3315
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0168182085R0202X
OH340093022085R0202X
CA20A137362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$-00OtherWORKERS COMP
OH000000595717OtherANTHEM BCBS
OHCK1297OtherRAILROAD MEDICARE
OH4250341Medicare PIN