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Bruce Lancel Bernardo Lara, SUBMARINEIDC
Military Health Care Provider in Groton, N/A
NPI 1912558610

Bruce Lancel Bernardo Lara is a Military Health Care Provider based in Groton, . Bruce Lancel Bernardo Lara practices in Groton, and has the professional credentials of SUBMARINEIDC. The NPI Number for Bruce Lancel Bernardo Lara is 1912558610 and holds a License No. (N/A).

The current practice location address for Bruce Lancel Bernardo Lara is Fpo, Ae, 09587-2417, Groton, and can be reached out via phone at 714-343-4488.

Location: Fpo, Ae, 09587-2417, Groton, , 06340-2516
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1912558610
Provider Name
Bruce Lancel Bernardo Lara
Credential
SUBMARINEIDC
Provider Entity Type
Individual
Gender
Male
Address
Fpo, Ae, 09587-2417, Groton, , 06340-2516
Phone Number
714-343-4488
Fax Number
Provider Enumeration Date
09/24/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
Fpo, Ae, 09587-2417
City
Groton
State
Zip
06340
Phone Number
714-343-4488
Fax Number
person
Provider Business Mailing Address Details
Address
Fpo, Ae, 09587-2417
City
Groton
State
Zip
06340
Phone Number
714-343-4488
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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