| Doctor Name: | CARMEN L. LASTINE |
| NPI Number: | 1699907915 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.V.M. |
| License Number: | 3964 |
| Business Practice Address: | 456 Kokopelli Blvd Unit E Fruita, CO - 815218723 |
| Business Phone Number: | 9708584299 |
| Business Fax Number: | |
| Mailing Address: | 2076 Victorian Ln, GRAND JUNCTION |
| State: | CO |
| Postal Code: | 815058308 |
| Phone Number: | 9702015191 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2009 |
| NPI Last Update Date: | 08/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174M00000X |
| License Number: | 3964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Veterinarian |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery. |