Provider Demographics
NPI:1275420465
Name:LARA, JENNIFER MARIA
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIA
Last Name:LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 E FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3511
Mailing Address - Country:US
Mailing Address - Phone:760-985-1102
Mailing Address - Fax:
Practice Address - Street 1:1533 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3511
Practice Address - Country:US
Practice Address - Phone:760-985-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula