Individual
GLENNYN WONG LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7100 W 20TH AVE STE 212, HIALEAH, FL 33016-1812
(305) 504-2117
(305) 504-2117
Mailing address
4300 NW 173RD DR, MIAMI GARDENS, FL 33055-3706
(786) 302-8511
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
9614896
FL
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
10/03/2011
Last updated
01/25/2026
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