| Mark W. Lastarza, M.d., Pa. | |
|
335 Clyde Morris Blvd Suite 290 Ormond Beach FL 32174-3181 | |
| (386) 672-3219 | |
| (386) 672-3160 |
| Full Name | Mark W. Lastarza, M.d., Pa. |
|---|---|
| Speciality | Internal Medicine |
| Location | 335 Clyde Morris Blvd, Ormond Beach, Florida |
| Authorized Official Name and Position | Mark Lastarza (DIRECTOR) |
| Authorized Official Contact | 3866723219 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark W. Lastarza, M.d., Pa. 335 Clyde Morris Blvd Suite 290 Ormond Beach FL 32174-3181 Ph: (386) 672-3219 | Mark W. Lastarza, M.d., Pa. 335 Clyde Morris Blvd Suite 290 Ormond Beach FL 32174-3181 Ph: (386) 672-3219 |
| NPI Number | 1043623598 |
|---|---|
| Provider Enumeration Date | 06/03/2014 |
| Last Update Date | 02/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043623598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME75627 (Florida) | Primary |
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