Individual
DR. JEANETTE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
204 ANGELINA BLVD, CHAPARRAL, NM 88081-7558
(758) 248-1005
(575) 824-8101
Mailing address
204 ANGELINA BLVD, CHAPARRAL, NM 88081-7558
(758) 248-1005
(575) 824-8101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-2410-20
NM
207Q00000X
Family Medicine Physician
R-25-2017
NM
Other
Enumeration date
06/05/2017
Last updated
12/11/2020
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