Provider Demographics
NPI:1376722454
Name:LASTIMOSO, FLEDZ LERIOS (RN)
Entity Type:Individual
Prefix:
First Name:FLEDZ
Middle Name:LERIOS
Last Name:LASTIMOSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 BERRY PATCH DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-7265
Mailing Address - Country:US
Mailing Address - Phone:907-644-1055
Mailing Address - Fax:907-644-1055
Practice Address - Street 1:8340 NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4663
Practice Address - Country:US
Practice Address - Phone:907-677-9909
Practice Address - Fax:907-644-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100639310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility