Individual
CHEYANNE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 N CALIFORNIA ST, STOCKTON, CA 95202-1515
(209) 468-2393
Mailing address
1350 BUCKINGHAM WAY APT 25, STOCKTON, CA 95207-4914
(209) 665-6658
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/25/2023
Last updated
10/16/2023
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