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Individual

DR. PEGGY L DE LARA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
A.P., OMD

Contact information

Practice address
2555 2ND AVE N, ST PETERSBURG, FL 33713-8705
(727) 385-7528
(727) 321-1178
Mailing address
PO BOX 10493, ST PETERSBURG, FL 33733-0493
(727) 385-7528
(727) 321-1178

Taxonomy

Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AP 1751
FL
225200000X
Physical Therapy Assistant
Primary
PTA2040
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
106898
MEDICARE ID
FL
Enumeration date
07/19/2006
Last updated
04/20/2009
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