Individual
DR. MARIE-ALICE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10000 STIRLING RD, SUITE 3, COOPER CITY, FL 33024-8067
(954) 517-9166
(954) 517-9167
Mailing address
PO BOX 848127, PEMBROKE PINES, FL 33084-0127
(954) 517-9166
(954) 517-9167
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME79139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170211
HUMANA
FL
01
—
1722315001
CIGNA
FL
01
—
2039274
UNITED HEALTH CARE
FL
01
—
274662
WELLCARE
FL
01
—
295786
AV-MED
FL
01
—
35540
BLUE CROSS BLUE SHIELD
FL
01
—
7477630
AETNA
FL
Enumeration date
09/19/2005
Last updated
04/02/2008
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