Provider Demographics
NPI:1720156755
Name:GATTONI, LEA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:LOUISE
Last Name:GATTONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9399 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8506
Mailing Address - Country:US
Mailing Address - Phone:303-840-1472
Mailing Address - Fax:
Practice Address - Street 1:9399 CROWN CREST BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8506
Practice Address - Country:US
Practice Address - Phone:303-840-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101705Medicare PIN