Basic Information
| Provider Information | |||||||||
| NPI: | 1235649682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASTRA | ||||||||
| FirstName: | ANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 WILSHIRE BLVD STE 300A | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 LAKES DR STE 320 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2017 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-27246 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.