Provider Demographics
NPI:1376001347
Name:LUGO, DIANA (LMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HUTCHINS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915-1163
Mailing Address - Country:US
Mailing Address - Phone:671-480-7208
Mailing Address - Fax:
Practice Address - Street 1:7 HUTCHINS ST
Practice Address - Street 2:
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96915-1163
Practice Address - Country:US
Practice Address - Phone:671-480-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty