Provider Demographics
NPI:1457523433
Name:SOPCHAK, LARA A (LMP)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:A
Last Name:SOPCHAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N 50TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6052
Mailing Address - Country:US
Mailing Address - Phone:206-930-9838
Mailing Address - Fax:206-789-8846
Practice Address - Street 1:1628 DEXTER AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3019
Practice Address - Country:US
Practice Address - Phone:206-295-0123
Practice Address - Fax:206-789-8846
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker