Healthcare Provider Details

I. General information

NPI: 1902664261
Provider Name (Legal Business Name): MATTEO LASPRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

10601 WASHINGTON BLVD
CULVER CITY CA
90232-3385
US

V. Phone/Fax

Practice location:
  • Phone: 312-478-8772
  • Fax:
Mailing address:
  • Phone: 312-478-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number17517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: