Provider Demographics
NPI:1245743061
Name:LASTIMOSA, PATRICK A
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:A
Last Name:LASTIMOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 THROCKMORTON STREET UNIT 3309
Mailing Address - Street 2:
Mailing Address - City:FORTH WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102
Mailing Address - Country:US
Mailing Address - Phone:817-908-8124
Mailing Address - Fax:817-885-7339
Practice Address - Street 1:500 THROCKMORTON ST APT 3309
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3820
Practice Address - Country:US
Practice Address - Phone:817-908-8124
Practice Address - Fax:817-885-7339
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic