Provider Demographics
NPI:1407079569
Name:LASTRA CALDERON, PEDRO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
Last Name:LASTRA CALDERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA 13 BE25
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-748-8978
Mailing Address - Fax:787-748-8978
Practice Address - Street 1:3 CALLE AUTONOMIA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3246
Practice Address - Country:US
Practice Address - Phone:787-876-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7262208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038914800Medicaid
PR28565OtherSSS
PR500097EOtherMMM
PR28565OtherSSS