Healthcare Provider Details

I. General information

NPI: 1366037152
Provider Name (Legal Business Name): ASTRANACARE PARTNERS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 S GARFIELD AVE FL 2
ALHAMBRA CA
91801-5400
US

IV. Provider business mailing address

1668 S GARFIELD AVE FL 2
ALHAMBRA CA
91801-5400
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-0288
  • Fax:
Mailing address:
  • Phone: 626-282-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LAUTRUP
Title or Position: GENERAL COUNSEL
Credential:
Phone: 818-821-7727