Individual
LARA NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
768 PLEASANT VALLEY RD STE 201, DIAMOND SPRINGS, CA 95619-9260
(530) 621-6290
Mailing address
768 PLEASANT VALLEY RD STE 201, DIAMOND SPRINGS, CA 95619-9260
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
95263970
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95263970
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
95263970
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
01
—
5874
HEALTH PARTNERS
—
Enumeration date
07/07/2023
Last updated
07/07/2023
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