Provider Demographics
NPI:1043677289
Name:LASTRAPE, KITA
Entity type:Individual
Prefix:MISS
First Name:KITA
Middle Name:
Last Name:LASTRAPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KITA
Other - Middle Name:
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:5957 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1609
Mailing Address - Country:US
Mailing Address - Phone:310-567-0037
Mailing Address - Fax:
Practice Address - Street 1:41945 BIG BEAR BLVD STE 222
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-2030
Practice Address - Country:US
Practice Address - Phone:909-866-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586627363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health