Angie J Lastra, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

ME121548 Issued in FL

Practice address

3702 Washington St Ste 303
Hollywood, FL 33021

Phone

(954) 518-2424

Fax

(954) 981-3476

NPI assigned

Dec 14, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Broward Hospital District

  • Physical Medicine & Rehabilitation Physician
  • Hollywood, FL
  • NPI 1750726378
  Medicare reassignment NPD
• South Broward Hospital District

  • Home Infusion Therapy Pharmacy
  • Miramar, FL
  • NPI 1043656614
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1629347083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST STE 303",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "954-518-2424",
            "fax_number": "954-981-3476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASTRA",
        "first_name": "ANGIE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-14",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME121548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017377500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Levinson DO PA
• Larry Shulruff MD PA
• Wayne Larson, MD
• Las Mercedes Adult Day Care V, LLC
• Stephanie N. Lasky, DO
• Tazlee Latif
• Lato Drug Company Inc
• Larry A Latson, MD
• Debra Lau, M.D.
• Hoi Ting Lau

• Physical Medicine & Rehabilitation Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.