Provider Demographics
NPI:1023072980
Name:DE LARA, VILMA ALOJADO (MD)
Entity type:Individual
Prefix:DR
First Name:VILMA
Middle Name:ALOJADO
Last Name:DE LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-6123
Mailing Address - Country:US
Mailing Address - Phone:973-777-1492
Mailing Address - Fax:973-777-0873
Practice Address - Street 1:178 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-6123
Practice Address - Country:US
Practice Address - Phone:973-777-1492
Practice Address - Fax:973-777-0873
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-16
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54-126Medicare UPIN