Basic Information
| Provider Information | |||||||||
| NPI: | 1881793685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOBLONSKI | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E CAMELBACK RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850182327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331814 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3333 E VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850086812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029330945 | ||||||||
| FaxNumber: | 6029334263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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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 | 208000000X | 25745 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4877110 | 01 | DES | OTHER | 00037551 | 01 | BANNER HEALTH PLAN | OTHER | AZ0766020 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 2Z1863 | 01 | HEALTHNET | OTHER | 487711 | 01 | AZ | AHCCCS | OTHER | 487711001 | 01 | APIPA | OTHER |