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General NPI Number Information
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NPI Number | 1518076298
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Entity Type | Individual
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Provider Name | LYN MARIE BERUTTI DO
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 190 S PEYTONVILLE AVE STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6937
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Country | US
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Telephone | 817-912-1600
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Fax | 817-912-1603
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Provider Business Mailing Address
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Address Line | 190 S PEYTONVILLE AVE STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6937
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Country | US
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Telephone | 817-912-1600
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Fax | 817-912-1603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J3990
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License Number State | TX
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