Individual
IRA T LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 456-8068
(714) 456-3765
Mailing address
PO BOX 54559, LOS ANGELES, CA 90054-0559
(714) 456-8068
(714) 456-3765
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
C40813
CA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
C40813
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C408130
MEDI-CAL PROVIDER #
CA
Enumeration date
05/17/2006
Last updated
03/12/2012
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