Provider Demographics
NPI:1609682681
Name:LARA, MATY M
Entity type:Individual
Prefix:
First Name:MATY
Middle Name:M
Last Name:LARA
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 1:216 KIRK CIR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28016-7786
Mailing Address - Country:US
Mailing Address - Phone:323-690-8223
Mailing Address - Fax:
Practice Address - Street 1:216 KIRK CIR
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-7786
Practice Address - Country:US
Practice Address - Phone:323-690-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter