MEDICARE: LUIS LACERNACASTILLO

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	163W00000X	Registered Nurse	0001321976	VA
2	367500000X	Certified Registered Nurse Anesthetist	0024193906	VA

General Provider Information

NPI Number	:	1598657827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS LACERNACASTILLO

Provider Business Mailing Address
First Line	:	1644 E 55TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-5555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 402 BOX 1184
Second Line	:
City	:	APO
State	:	AE
Zip	:	09180-0012
Country	:	US
Telephone Number	:	213-924-2687
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “ LUIS LACERNACASTILLO ” Practice Location

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