Provider Demographics
NPI:1730408808
Name:LOTT, KAREN DENISE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:LOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0806
Mailing Address - Country:US
Mailing Address - Phone:209-408-8399
Mailing Address - Fax:209-408-8399
Practice Address - Street 1:3013 TULLY RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0806
Practice Address - Country:US
Practice Address - Phone:209-408-8399
Practice Address - Fax:209-408-8399
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA024055060171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor