Provider Demographics
NPI:1245678127
Name:LARA, DARLENE SHERRI (DC)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:SHERRI
Last Name:LARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LILLE LN APT 203
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-1607
Mailing Address - Country:US
Mailing Address - Phone:949-650-1364
Mailing Address - Fax:
Practice Address - Street 1:336 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-3033
Practice Address - Country:US
Practice Address - Phone:949-673-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20675111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation