1801692090 NPI number — WEST COAST PSYCHIATRY ASSOCIATES, PC

Table of content: DR. WENDY LYNN LARA DDS (NPI 1821094228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801692090 NPI number — WEST COAST PSYCHIATRY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST PSYCHIATRY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1801692090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 HIGHLAND POINTE DR STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95678-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-486-5225
Provider Business Mailing Address Fax Number:
833-603-1298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-7773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-486-5225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2025

Additional Information

Authorized Official

Authorized Official Last Name:
REINER
Authorized Official First Name:
WADE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-486-5225

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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