Individual
MICHAEL LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1714 ALABAMA ST, HUNTINGTON BEACH, CA 92648-3124
(714) 673-8327
Mailing address
1714 ALABAMA ST, HUNTINGTON BEACH, CA 92648-3124
(714) 673-8327
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D4622640
CA
Other
Enumeration date
12/28/2012
Last updated
12/31/2012
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