Healthcare Provider Details

I. General information

NPI: 1639740533
Provider Name (Legal Business Name): DEREK JAMES LANUTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

IV. Provider business mailing address

1511 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberV3363
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA208448
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA208448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: