Basic Information
| Provider Information | |||||||||
| NPI: | 1467578047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARA | ||||||||
| FirstName: | MELLANI | ||||||||
| MiddleName: | MALLARI | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53941 CALLE SANBORN | ||||||||
| Address2: | |||||||||
| City: | COACHELLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922363139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602180196 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 81557 DR CARREON BLVD STE C9 | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922015562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603916999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 197993 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.