Provider Demographics
NPI:1497462006
Name:LUMAGUE, ROELLA SARNO
Entity Type:Individual
Prefix:
First Name:ROELLA
Middle Name:SARNO
Last Name:LUMAGUE
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:PO BOX 10192
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91309-1192
Mailing Address - Country:US
Mailing Address - Phone:818-282-3500
Mailing Address - Fax:
Practice Address - Street 1:5970 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1150
Practice Address - Country:US
Practice Address - Phone:323-234-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33913124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist