Individual
JACOB LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7000 PROSPECT PL NE, ALBUQUERQUE, NM 87110-4359
(505) 616-0815
Mailing address
5001 W LEA DR SW, ALBUQUERQUE, NM 87105-6377
(505) 210-0209
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/06/2024
Last updated
12/06/2024
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