Healthcare Provider Details

I. General information

NPI: 1841627072
Provider Name (Legal Business Name): MS. MARY K LAGATTUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8509 BENJAMIN RD SUITE D
TAMPA FL
33634-1224
US

IV. Provider business mailing address

410 MERLIN CT
BRANDON FL
33510-3033
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-8521
  • Fax:
Mailing address:
  • Phone: 727-432-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: