Provider Demographics
NPI:1578718029
Name:LUGO, ADRIAN ALEXANDRO (RDHAP)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:ALEXANDRO
Last Name:LUGO
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 GROSSMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4148
Mailing Address - Country:US
Mailing Address - Phone:760-554-2608
Mailing Address - Fax:
Practice Address - Street 1:9414 GROSSMONT BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4148
Practice Address - Country:US
Practice Address - Phone:760-554-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20884124Q00000X
CA111124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist