Provider Demographics
NPI:1386316032
Name:LASTRES, CLAUDIA (PMHNP)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:LASTRES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 W 36TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1847
Mailing Address - Country:US
Mailing Address - Phone:786-548-8625
Mailing Address - Fax:
Practice Address - Street 1:8195 W 36TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1847
Practice Address - Country:US
Practice Address - Phone:786-548-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLAPRN11036746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty