Individual
ANGIE J LASTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3702 WASHINGTON ST STE 303, HOLLYWOOD, FL 33021
(954) 518-2424
(954) 981-3476
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME121548
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017377500
—
FL
Enumeration date
12/14/2011
Last updated
06/27/2018
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