Individual
MS. DESTINY MARIE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Mailing address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/28/2020
Last updated
05/05/2025
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