Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 308492 | NY |
NPI | 1013416593 |
---|---|
Provider Name | Mr. Jose Ramon Lara |
First Address | Durham, NC 27707-3360 |
Second Address | Brooklyn, NY 11216-3903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2018 |
Last Update Date | 10/08/2021 |