Provider Demographics
NPI:1952650210
Name:LACHICA, TARA LEE M (RDHAP)
Entity Type:Individual
Prefix:MISS
First Name:TARA LEE
Middle Name:M
Last Name:LACHICA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15413 ELM LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2929
Mailing Address - Country:US
Mailing Address - Phone:909-525-2375
Mailing Address - Fax:
Practice Address - Street 1:12654 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9168
Practice Address - Country:US
Practice Address - Phone:909-525-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 398124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist