1669928933 NPI number — KARLENA LARA-OTERO PH.D., M.SC.

Table of content: KARLENA LARA-OTERO PH.D., M.SC. (NPI 1669928933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669928933 NPI number — KARLENA LARA-OTERO PH.D., M.SC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARA-OTERO
Provider First Name:
KARLENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., M.SC.
Provider Gender Code:
F

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:
1669928933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1432 W SAN CARLOS ST
Provider Second Line Business Mailing Address:
APT #474
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-374-6939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2589 SAMARITAN DRIVE, FLOOR 3
Provider Second Line Business Practice Location Address:
MAIL CODE: 7532
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
669-233-2363
Provider Business Practice Location Address Fax Number:
669-233-2072
Provider Enumeration Date:
08/28/2016

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: 170300000X , with the licence number:  GC000796 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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