Provider Demographics
NPI:1982040127
Name:LOTTIS & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:LOTTIS & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FNP-BC
Authorized Official - Phone:928-684-3153
Mailing Address - Street 1:55 E. YAVAPAI ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390
Mailing Address - Country:US
Mailing Address - Phone:928-684-3153
Mailing Address - Fax:928-684-3141
Practice Address - Street 1:55 E. YAVAPAI ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-3153
Practice Address - Fax:928-684-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3541261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center