Provider Demographics
NPI:1326123209
Name:LAGS SPINE & SPORTSCARE MEDICAL CENTERS INC
Entity Type:Organization
Organization Name:LAGS SPINE & SPORTSCARE MEDICAL CENTERS INC
Other - Org Name:LAGS SPINE AND SPORTS CARE MEDICAL CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAGATTUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-7361
Mailing Address - Street 1:135 CARMEN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7729
Mailing Address - Country:US
Mailing Address - Phone:805-928-7361
Mailing Address - Fax:805-928-5742
Practice Address - Street 1:29 W MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2509
Practice Address - Country:US
Practice Address - Phone:805-884-4019
Practice Address - Fax:805-884-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
106049805OtherUSDL
CA7263464OtherAETNA PIN
CAGR0098091Medicaid
CAZZZ09771ZOtherBLUE SHIELD OF CA
CA7263464OtherAETNA PIN
CA5197200005Medicare NSC