Provider Demographics
NPI:1730304098
Name:LUGAR, CLINTON BRENT (MHRS)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:BRENT
Last Name:LUGAR
Suffix:
Gender:M
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SANTA CLARA DR STE 145
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3500
Mailing Address - Country:US
Mailing Address - Phone:916-779-2455
Mailing Address - Fax:
Practice Address - Street 1:1624 SANTA CLARA DR STE 145
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3500
Practice Address - Country:US
Practice Address - Phone:916-779-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator