Active NPI
Lisa Tungovia
- Technician
- Polacca, AZ
National Provider Identifier
1740647734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician
- License
- 899436
- Practice address
- Hwy 264 Mile Post 388
Polacca, AZ 86042 - Phone
- (928) 734-6000
- NPI assigned
- Jan 21, 2016
- Last updated
- Jan 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician | 374700000X | 899436 | AZ | Primary |
Addresses
Primary practice location
Hwy 264 Mile Post 388
Polacca, AZ 86042
Mailing address
Hwy 264 Mile Post 388
Polacca, AZ 86042
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020529 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 899436 | AZ | MD | Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453334400000",
"number": "1740647734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HWY 264 MILE POST 388",
"city": "POLACCA",
"state": "AZ",
"postal_code": "86042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 264 MILE POST 388",
"city": "POLACCA",
"state": "AZ",
"postal_code": "86042",
"telephone_number": "928-734-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUNGOVIA",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-21",
"last_updated": "2016-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "374700000X",
"taxonomy_group": "",
"desc": "Technician",
"state": "AZ",
"license": "899436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020529",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Polacca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.