Lara Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A696530 Issued in CA

Legal business name

LARA MEDICAL CORPORATION

Practice address

8033 Vineland Avenue
Attn Fidel M. Lara Jr MD
Sun Valley, CA 91352-3951

Phone

(818) 767-1001

Fax

(818) 767-1991

NPI assigned

Dec 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fidel M. Lara Jr., M.D.NPI 1194909481

Title

President Ceo

Phone

(818) 767-1001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lara Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fidel M Lara Jr., M.D.

  • Internal Medicine Physician
  • Sun Valley, CA
  • NPI 1194909481
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1508924788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8033 VINELAND AVENUE",
            "address_2": "ATTN FIDEL M. LARA JR MD",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913523951",
            "telephone_number": "818-767-1001",
            "fax_number": "818-767-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8033 VINELAND AVENUE",
            "address_2": "ATTN FIDEL M. LARA JR MD",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913523951",
            "telephone_number": "818-767-1001",
            "fax_number": "818-767-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARA MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "LARA",
        "authorized_official_first_name": "FIDEL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "818-767-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A696530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A696530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lara Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sharon Stasha Kukkiriza
• Virgil Leon Adrian Jr La Flora
• La Tuna Home
• La United Home Health Care Inc
• Brittney Langworthy
• Lara Pharmacy Corporation
• Fidel M Lara Jr., M.D.
• Laurel Canyon Dialysis, LLC
• Laurel Canyon Medical Equipment, Inc.
• Shaema Lynn Lavoie

• Internal Medicine Physician in Sun Valley, CA
• Providers in Sun Valley, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.