Provider Demographics
NPI:1235582453
Name:LUGOTOFF, JESSICA RAE (BA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:LUGOTOFF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S POLI ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2144
Mailing Address - Country:US
Mailing Address - Phone:805-272-5564
Mailing Address - Fax:
Practice Address - Street 1:11311 SANTA ANA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-9769
Practice Address - Country:US
Practice Address - Phone:805-649-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program