Provider Demographics
NPI:1184089898
Name:LASTRA, BELEN ALEJANDRA (RN)
Entity type:Individual
Prefix:MS
First Name:BELEN
Middle Name:ALEJANDRA
Last Name:LASTRA
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 1:1125 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2217
Mailing Address - Country:US
Mailing Address - Phone:707-674-1822
Mailing Address - Fax:
Practice Address - Street 1:1125 OXFORD CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2217
Practice Address - Country:US
Practice Address - Phone:707-674-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95076387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse