Provider Demographics
NPI:1386029056
Name:LASTRINA, RICHARD SR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LASTRINA
Suffix:SR
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 1:81 WINSLOW DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4925
Mailing Address - Country:US
Mailing Address - Phone:860-667-3176
Mailing Address - Fax:
Practice Address - Street 1:769 NEWFIELD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:860-635-4886
Practice Address - Fax:860-635-7087
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0134237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1598891855Medicaid