Provider Demographics
NPI:1609685775
Name:LARUE-STERNBERG, CIARA DAWN (CPSS)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:DAWN
Last Name:LARUE-STERNBERG
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 A ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2199
Mailing Address - Country:US
Mailing Address - Phone:619-235-0593
Mailing Address - Fax:
Practice Address - Street 1:2516 A ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2199
Practice Address - Country:US
Practice Address - Phone:619-235-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-CPVNUT175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist