Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0003837 | FL |
NPI | 1265577548 |
---|---|
Provider Name | Dr. Roland M Lastarza |
First Address | Orlando, FL 32812-2115 |
Second Address | Orlando, FL 32809-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 25/05/2011 |