Provider Demographics
NPI:1447244256
Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS INC
Entity Type:Organization
Organization Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS INC
Other - Org Name:
Other - Org Type:
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 1:801 E CHAPEL ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4607
Mailing Address - Country:US
Mailing Address - Phone:805-928-7361
Mailing Address - Fax:805-928-5742
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:STE. 1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-928-7361
Practice Address - Fax:805-928-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185952081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
106049801OtherUSDL
CAGR098092OtherSBHA
CA7263464OtherAETNA PIN
CAZZZ09770ZOtherBLUE SHIELD OF CA
CAGR0098092Medicaid
CAZZZ09770ZOtherBLUE SHIELD OF CA
106049801OtherUSDL
CAZZZ09770ZOtherBLUE SHIELD OF CA
CA5197200001Medicare NSC
CAW17810AMedicare PIN