Provider Demographics
NPI:1851686927
Name:LUO, LUGUANG (DA)
Entity Type:Individual
Prefix:
First Name:LUGUANG
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PROSPECT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4429
Mailing Address - Country:US
Mailing Address - Phone:508-837-7343
Mailing Address - Fax:
Practice Address - Street 1:126 PROSPECT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4429
Practice Address - Country:US
Practice Address - Phone:508-837-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist