Individual
VICENTE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPH
Contact information
Practice address
2611 10TH AVE, OAKLAND, CA 94606-2707
(510) 779-3188
Mailing address
2611 10TH AVE, OAKLAND, CA 94606-2707
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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