# WILFREDO CONSTANTINO LARA MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063605913
- **Authorized official:** WILFREDO CONSTANTINO LARA MD (OWNER)
- **Authorized official phone:** (305) 643-8871

## Contact information

- **Practice address:** 351 NW 42ND AVE, SUITE 302, MIAMI, FL 33126-5683
- **Practice address phone:** (305) 643-8871
- **Practice address fax:** (305) 643-8872
- **Mailing address:** PO BOX 144336, CORAL GABLES, FL 33114-4336
- **Mailing address phone:** (305) 643-8871
- **Mailing address fax:** (305) 643-8872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | FL | Yes |

## Other

- **Enumeration date:** 08/23/2007
- **Last updated:** 05/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 446289 | MEDICA HEALTHCARE | FL |
| 01 | — | 8796542 | CIGNA | FL |