Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC20675 | CA |
NPI | 1245678127 |
---|---|
Provider Name | Dr. Darlene Sherri Lara |
First Address | Newport Beach, CA 92663-1607 |
Second Address | Corona Del Mar, CA 92625-3033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 12/06/2013 |