MEDICARE: MANUEL RAY LASTRA-CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1174472393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL RAY LASTRA-CRUZ

Provider Business Mailing Address
First Line	:	PO BOX 782068
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78278-2068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 WEST AVE STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1837
Country	:	US
Telephone Number	:	210-580-4149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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