Provider Demographics
NPI:1669928933
Name:LARA-OTERO, KARLENA (PHD, MSC)
Entity type:Individual
Prefix:
First Name:KARLENA
Middle Name:
Last Name:LARA-OTERO
Suffix:
Gender:F
Credentials:PHD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 W SAN CARLOS ST
Mailing Address - Street 2:APT #474
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3217
Mailing Address - Country:US
Mailing Address - Phone:202-374-6939
Mailing Address - Fax:
Practice Address - Street 1:2589 SAMARITAN DRIVE, FLOOR 3
Practice Address - Street 2:MAIL CODE: 7532
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:669-233-2363
Practice Address - Fax:669-233-2072
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000796170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS