Individual
AMANDA DE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 TECHNOLOGY CT STE 105, RIVERSIDE, CA 92507-2181
(951) 686-8500
Mailing address
525 TECHNOLOGY CT STE 105, RIVERSIDE, CA 92507-2181
(951) 686-8500
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11882
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/14/2022
Last updated
06/27/2024
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