Individual
GREGORY GERARD LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1420 S CENTRAL AVE, GLENDALE, CA 91204-2508
(818) 502-2252
(818) 502-2317
Mailing address
225 S LAKE AVE, 535, PASADENA, CA 91101-3005
(626) 795-6596
(626) 795-8247
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A69087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A811150
BLUE SHIELD
CA
05
—
00A811150
—
CA
Enumeration date
07/27/2006
Last updated
02/14/2014
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