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NPI Code Detail

MEDICARE: LOIS GAUTAM

MEDICARE: LOIS GAUTAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133VN1004XPediatric Nutrition Registered Dietitian
2133V00000XRegistered DietitianLDD10219556OR
3133V00000XRegistered DietitianDI60524624WA
4133V00000XRegistered DietitianWA

General Provider Information

NPI Number : 1215419494
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOIS GAUTAM
Provider Business Mailing Address
First Line : 10203 18TH AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98146-1315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4800 SAND POINT WAY NE
Second Line :
City : SEATTLE
State : WA
Zip : 98105-3901
Country : US
Telephone Number : 206-987-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 12/15/2025

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Directions to “ LOIS GAUTAM ” Practice Location

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