Individual
SERGIO LUSTRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4111 ALDERWOOD MALL BLVD, LYNNWOOD, WA 98036-6765
(425) 977-2560
Mailing address
4111 ALDERWOOD MALL BLVD, LYNNWOOD, WA 98036-6765
(425) 977-2560
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9HP000482739
—
WA
Enumeration date
02/22/2019
Last updated
02/22/2019
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