Provider Demographics
NPI:1598897423
Name:TAUTIVA, LISA M (RDMS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TAUTIVA
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2719
Mailing Address - Country:US
Mailing Address - Phone:781-834-3888
Mailing Address - Fax:781-834-3888
Practice Address - Street 1:60 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5224
Practice Address - Country:US
Practice Address - Phone:508-771-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37159246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA80314OtherUNICARE
MAAA24533OtherHARVARD PILGRIM
MA039469OtherBLUE CROSS BLUE SHIELD
MA3755396OtherAETNA
MA80314OtherUNICARE