Healthcare Provider Details

I. General information

NPI: 1235651639
Provider Name (Legal Business Name): ANA MARIA LASTRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE # 5WOPD
LOS ANGELES CA
90033-1026
US

IV. Provider business mailing address

1640 MARENGO ST STE 300
LOS ANGELES CA
90033-1075
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-2200
  • Fax:
Mailing address:
  • Phone: 323-865-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number521203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: