Individual
MR. ERNESTO ALFONSO LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T
Contact information
Practice address
5405 SE ALEXANDER ST, HILLSBORO, OR 97123-8584
(971) 409-8301
Mailing address
2520 SW 204TH AVE, BEAVERTON, OR 97006-1871
(971) 409-8301
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17920
OR
Other
Enumeration date
12/14/2012
Last updated
03/14/2013
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