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General NPI Number Information
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NPI Number | 1699907915
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Entity Type | Individual
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Provider Name | CARMEN L. LASTINE D.V.M.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 456 KOKOPELLI BLVD UNIT E
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City | FRUITA
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State | CO
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Zip | 81521-8723
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Country | US
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Telephone | 970-858-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 2076 VICTORIAN LN
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-8308
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Country | US
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Telephone | 970-201-5191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 3964
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License Number State | OK
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