Provider Demographics
NPI:1457033623
Name:LOTIA CORP
Entity Type:Organization
Organization Name:LOTIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-981-2755
Mailing Address - Street 1:1324 KELLYBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4678
Mailing Address - Country:US
Mailing Address - Phone:508-981-2755
Mailing Address - Fax:
Practice Address - Street 1:1324 KELLYBROOK WAY
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4678
Practice Address - Country:US
Practice Address - Phone:508-981-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty