Individual
CARLOS A LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA59353
Contact information
Practice address
10715 SW 224TH ST, MIAMI, FL 33170-6562
(786) 488-4696
Mailing address
10715 SW 224TH ST, MIAMI, FL 33170-6562
(786) 488-4696
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA59353
FL
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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