Provider Demographics
NPI:1992799704
Name:LAGATTUTA, FRANCIS P (MD)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:P
Last Name:LAGATTUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CARMEN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7729
Mailing Address - Country:US
Mailing Address - Phone:805-928-7361
Mailing Address - Fax:805-332-3750
Practice Address - Street 1:135 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7729
Practice Address - Country:US
Practice Address - Phone:805-928-7361
Practice Address - Fax:805-332-3750
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170958208100000X
DEC1-0013339208100000X
WAMD60538273208100000X
NV17609208100000X
FLME1273472081P2900X
CAG843342081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G843340OtherBLUE SHIELD PIN
CA00G843340Medicaid
CA4259229OtherAETNA PIN
CAP00118004Medicare PIN
CA00G843340OtherBLUE SHIELD PIN
CAC48791Medicare UPIN
CAWG84334AMedicare PIN