Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 080531 | IA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 3947 | NV |
NPI | 1033574884 |
---|---|
Provider Name | Lara Arevalo Tyler |
First Address | Sparks, NV 89434-7866 |
Second Address | Sparks, NV 89434-7866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 03/10/2019 |