Provider Demographics
NPI:1790403913
Name:HAMILTON, LASTARR TRINETTA (LVN)
Entity Type:Individual
Prefix:
First Name:LASTARR
Middle Name:TRINETTA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11548 216TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2588
Mailing Address - Country:US
Mailing Address - Phone:562-380-5052
Mailing Address - Fax:
Practice Address - Street 1:11548 216TH ST APT 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2588
Practice Address - Country:US
Practice Address - Phone:562-380-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212432164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty