Individual
FERNANDA KATHY LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 508-1800
Mailing address
400 N PEPPER AVE, COLTON, CA 92324-1801
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95247134
CA
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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