Most Relevant Information
Provider Data
| NPI Number: | 1003534363 |
| Provider Name: | MARISSA ALEXZANDRIA LARA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/22/2022 |
| Last Updated: | 08/22/2022 |
Provider Practice Location
27990 SHERMAN RD
SUN CITY
CA
925859155
Practice Location Phone/Fax
| Phone: | 9513099135 |
| Fax: |
Provider Mailing Location
5850 GRANITE PKWY STE 600
PLANO
TX
750246753
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |