Provider Demographics
NPI:1528389822
Name:LUGO-COLON & TOVANYAN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LUGO-COLON & TOVANYAN MEDICAL GROUP INC
Other - Org Name:SC MEDICAL & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROOT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-980-1221
Mailing Address - Street 1:11650 RIVERSIDE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1066
Mailing Address - Country:US
Mailing Address - Phone:818-980-1221
Mailing Address - Fax:818-980-3221
Practice Address - Street 1:11650 RIVERSIDE DR STE 6
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1066
Practice Address - Country:US
Practice Address - Phone:818-980-1221
Practice Address - Fax:818-980-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107410208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACF337AMedicare UPIN