Provider Demographics
NPI:1295282374
Name:LAREZ, JULIA (RN)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:LAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2337
Mailing Address - Country:US
Mailing Address - Phone:520-364-2447
Mailing Address - Fax:520-224-2430
Practice Address - Street 1:1132 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2337
Practice Address - Country:US
Practice Address - Phone:520-364-2447
Practice Address - Fax:520-224-2430
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN020024163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0718412Medicaid