Provider Demographics
NPI:1699907915
Name:LASTINE, CARMEN L (DVM)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:LASTINE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 VICTORIAN LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8308
Mailing Address - Country:US
Mailing Address - Phone:970-201-5191
Mailing Address - Fax:
Practice Address - Street 1:456 KOKOPELLI BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-8723
Practice Address - Country:US
Practice Address - Phone:970-858-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3964174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian