Lara, Gustavo
Lara, Gustavo is an individual health care provider with primary practice located at 7111 Indiana Ave Ste 100 , Riverside CA 92504. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Lara, Gustavo can be contacted via phone (951) 276-9012.Contact Information
Primary practice address
7111 Indiana Ave Ste 100
Riverside CA 92504
Phone: (951) 276-9012
Fax: (951) 276-9163
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | A77165 | California |
Profile Details
| NPI number | 1639132392 |
|---|---|
| LBN Legal business name | Lara, Gustavo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 11th, 2006 |
| Last updated | May 24th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639132392 | NPPES |
| California | MEDICAID | 00A771650 |
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