Individual
REBECCA I LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2337 AGUA FRIA DR NE, RIO RANCHO, NM 87144-6750
(505) 369-9489
Mailing address
2337 AGUA FRIA DR NE, RIO RANCHO, NM 87144-6750
(505) 369-9489
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/24/2019
Last updated
11/24/2019
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