Basic Information
| Provider Information | |||||||||
| NPI: | 1366032690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASKOSKIE | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1119 WILLIAMS LN | ||||||||
| Address2: | |||||||||
| City: | KEMAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775653106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322213191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3036 YALE ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770188434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557827822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2021 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-145174 | TX | Y |
No ID Information.