Organization
FORT LYON CORRECTIONAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL O. LASTRELLA M.D. (PHYSICIAN)
(719) 456-3222
Entity
Organization
Contact information
Practice address
30999 COUNTY RD 15, FORT LYON, CO 81038
(719) 456-3222
Mailing address
2862 S CIRCLE DR, COLORADO SPRINGS, CO 80906-4101
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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