Provider Demographics
NPI:1710300470
Name:DE LAMAR, NASTASIA
Entity Type:Individual
Prefix:MISS
First Name:NASTASIA
Middle Name:
Last Name:DE LAMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 NW 19TH AVE
Mailing Address - Street 2:BAY 16
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054
Mailing Address - Country:US
Mailing Address - Phone:305-915-9666
Mailing Address - Fax:
Practice Address - Street 1:13740 NW 19TH AVE
Practice Address - Street 2:BAY 16
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-4211
Practice Address - Country:US
Practice Address - Phone:305-915-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization