Provider Demographics
NPI:1487121828
Name:LAVA, KAREN LASTIMOSO
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LASTIMOSO
Last Name:LAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LAVA
Other - Last Name:BOLALIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-682-7730
Practice Address - Street 1:500 E RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1508
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-682-7730
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily