1851198303 NPI number — JASMINE ELISABEL LARA

Table of content: JASMINE ELISABEL LARA (NPI 1851198303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851198303 NPI number — JASMINE ELISABEL LARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARA
Provider First Name:
JASMINE
Provider Middle Name:
ELISABEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
X

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851198303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 WADE STEPHENSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLY SPRINGS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27540-8099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-943-2978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 447 BX 2 FPO-AP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AYASE
Provider Business Practice Location Address State Name:
KANAGAWA
Provider Business Practice Location Address Postal Code:
96306
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
515-943-2978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  14192610-1206 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)