Provider Demographics
NPI:1295077626
Name:LASTRA CASTELLUCCI, ROSANA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:LASTRA CASTELLUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 LANG CT N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2724
Mailing Address - Country:US
Mailing Address - Phone:134-019-8838
Mailing Address - Fax:
Practice Address - Street 1:336 LANG CT N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2724
Practice Address - Country:US
Practice Address - Phone:727-209-7213
Practice Address - Fax:601-429-9371
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140258208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics