Provider Demographics
NPI:1417252735
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:MS
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 1:592 S 13TH ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-3820
Practice Address - Country:US
Practice Address - Phone:805-928-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG843342081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5197200006Medicare NSC
CAW17810Medicare PIN