Provider Demographics
NPI:1003526864
Name:GATTONI, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GATTONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 ELEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4113
Mailing Address - Country:US
Mailing Address - Phone:925-477-8730
Mailing Address - Fax:
Practice Address - Street 1:1173 ELEVENTH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4113
Practice Address - Country:US
Practice Address - Phone:925-477-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist