Individual provider Active NPI

Hector Manrique Lastra, M.D.

  • Pediatrics Physician
  • Huntington Park, CA
National Provider Identifier
1982817128
Registry record updated Dec 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A91293 Issued in CA
Practice address
2750 E Slauson Ave
Huntington Park, CA 90255
Phone
(323) 581-3010
Fax
(323) 581-2035
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A91293 CA Primary

Addresses

Primary practice location

2750 E Slauson Ave
Huntington Park, CA 90255

Mailing address

2750 E Slauson Ave
Huntington Park, CA 90255
Phone (323) 581-3010

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20070801000868 CA Practitioner - Pediatric Medicine 4284725482 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A91293CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 3, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 3, 2019 Accepting new patients

Locations

9400 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-6064

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638576000000",
    "number": "1982817128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 E SLAUSON AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "90255",
            "telephone_number": "323-581-3010",
            "fax_number": "323-581-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 E SLAUSON AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "90255",
            "telephone_number": "323-581-3010",
            "fax_number": "323-581-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASTRA",
        "first_name": "HECTOR",
        "middle_name": "MANRIQUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2021-12-04",
        "certification_date": "2021-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A91293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "9400 Rosecrans Ave",
            "city": "Bellflower",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907062246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.