Provider Demographics
NPI:1205428455
Name:HERRICK, LARA KAYE
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:KAYE
Last Name:HERRICK
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 1:50 MAJESTIC CT APT 304
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-4110
Mailing Address - Country:US
Mailing Address - Phone:805-217-3088
Mailing Address - Fax:
Practice Address - Street 1:50 MAJESTIC CT APT 304
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-4110
Practice Address - Country:US
Practice Address - Phone:805-217-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program