Provider Demographics
NPI:1285246272
Name:DE LAS ALAS, LOURDES CLAIRE
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:CLAIRE
Last Name:DE LAS ALAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 SHEPHERD SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3114
Mailing Address - Country:US
Mailing Address - Phone:443-804-1522
Mailing Address - Fax:
Practice Address - Street 1:6005 SHEPHERD SQ
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3114
Practice Address - Country:US
Practice Address - Phone:443-804-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily