Provider Demographics
NPI:1669807111
Name:ALASANTRO, LORI HAASE (PHD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:HAASE
Last Name:ALASANTRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4219
Mailing Address - Country:US
Mailing Address - Phone:760-631-3000
Mailing Address - Fax:760-631-3016
Practice Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4219
Practice Address - Country:US
Practice Address - Phone:760-631-3000
Practice Address - Fax:760-631-3016
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25817103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical