Healthcare Provider Details

I. General information

NPI: 1134176696
Provider Name (Legal Business Name): JAMES ANTHONY LAGATTUTA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 4 PINON HEALTH CARE CLINIC
PIONON AZ
86510
US

IV. Provider business mailing address

P.O. DRAWER PH CHINLE COMPREHENSIVE HEALTH CARE FACILITY
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7166
  • Fax: 928-674-7705
Mailing address:
  • Phone: 928-674-7166
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1731
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: