Basic Information
| Provider Information | |||||||||
| NPI: | 1134176696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAGATTUTA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. DRAWER PH | ||||||||
| Address2: | CHINLE COMPREHENSIVE HEALTH CARE FACILITY | ||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747166 | ||||||||
| FaxNumber: | 9286747705 | ||||||||
| Practice Location | |||||||||
| Address1: | NAVAJO ROUTE 4 | ||||||||
| Address2: | PINON HEALTH CARE CLINIC | ||||||||
| City: | PIONON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747166 | ||||||||
| FaxNumber: | 9286747705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1731 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | B1267 | 01 | NC | MEDCOST | OTHER | 7815274 | 01 | NC | AETNA | OTHER | 045M6 | 01 | NC | BCBS NC | OTHER | 6000182 | 05 | NC | MEDICAID |