Basic Information
Provider Information
NPI: 1487844957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TATINENI
FirstName: LATHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7000 NORTH MOPAC
Address2: SUITE # 420
City: AUSTIN
State: TX
PostalCode: 78731
CountryCode: US
TelephoneNumber: 5124820045
FaxNumber: 5124769892
Practice Location
Address1: 7000 NORTH MOPAC
Address2: SUITE # 420
City: AUSTIN
State: TX
PostalCode: 78731
CountryCode: US
TelephoneNumber: 5124820045
FaxNumber: 5124769892
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 03/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XM9687TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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