Provider Demographics
NPI:1184938359
Name:BRIAN LUGO, M.D., MEDICAL CORP
Entity type:Organization
Organization Name:BRIAN LUGO, M.D., MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-768-4415
Mailing Address - Street 1:PO BOX 50187
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0187
Mailing Address - Country:US
Mailing Address - Phone:626-768-4415
Mailing Address - Fax:626-768-4421
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-768-4415
Practice Address - Fax:626-768-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 877042086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 87704OtherMEDICAL LICENSE