Basic Information
| Provider Information | |||||||||
| NPI: | 1891867206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARA | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932914918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596272046 | ||||||||
| FaxNumber: | 5596279079 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932914918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596272046 | ||||||||
| FaxNumber: | 5596279079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT23779 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.