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Individual
LARA L RIFE
Active
Individual
LARA L RIFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA052574
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103150363
—
PA
01
—
50070685
CAPITAL BLUE CROSS
PA
01
—
6622487
AETNA HMO
PA
01
—
867633
MEDICARE GROUP #
PA
01
—
9323234
AETNA NON HMO
PA
01
—
MA052574
LICENSE
PA
01
—
P00841805
RAILROAD MEDICARE
PA
Enumeration date
07/30/2006
Last updated
03/07/2023
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