Provider Demographics
NPI:1144805243
Name:LUGO SOTO, KATIRIA
Entity Type:Individual
Prefix:
First Name:KATIRIA
Middle Name:
Last Name:LUGO SOTO
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 1:8726 TIERRA VISTA CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1686
Mailing Address - Country:US
Mailing Address - Phone:407-946-1447
Mailing Address - Fax:
Practice Address - Street 1:8726 TIERRA VISTA CIR APT 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1686
Practice Address - Country:US
Practice Address - Phone:407-946-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator