Individual
MARIA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1916 N LOUIS TITTLE AVE, MANGUM, OK 73554-1629
(405) 402-5218
Mailing address
1916 N LOUIS TITTLE AVE, MANGUM, OK 73554-1629
(405) 402-5218
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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