Provider Demographics
NPI:1881138907
Name:LASAM, MARIA LOURDES (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:LASAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82934 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4308
Mailing Address - Country:US
Mailing Address - Phone:760-477-0733
Mailing Address - Fax:
Practice Address - Street 1:82934 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4308
Practice Address - Country:US
Practice Address - Phone:760-477-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily