Provider Demographics
NPI:1245425594
Name:LUGO, LAURETTA R
Entity Type:Individual
Prefix:MS
First Name:LAURETTA
Middle Name:R
Last Name:LUGO
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 1:6622 BLANCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3270
Mailing Address - Country:US
Mailing Address - Phone:909-357-1137
Mailing Address - Fax:909-357-1137
Practice Address - Street 1:6622 BLANCHARD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3270
Practice Address - Country:US
Practice Address - Phone:909-357-1137
Practice Address - Fax:909-357-1137
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033316343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)