Provider Demographics
NPI:1942476288
Name:LARA, MARIA GUADALUPE (MPH)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:LARA
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 SEMINOLE WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5687
Mailing Address - Country:US
Mailing Address - Phone:909-349-1761
Mailing Address - Fax:
Practice Address - Street 1:5822 SEMINOLE WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5687
Practice Address - Country:US
Practice Address - Phone:909-349-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator