Provider Demographics
NPI:1669235636
Name:OSTOLAZA, KASHLEY A
Entity type:Individual
Prefix:
First Name:KASHLEY
Middle Name:A
Last Name:OSTOLAZA
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:URB. ALTURAS DE JAYUYA 11 CALLE JOSE AULET VERGARA
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1465
Mailing Address - Country:US
Mailing Address - Phone:787-475-1029
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON,00966, PUERTO RICO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse