Provider Demographics
NPI:1316468127
Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Entity type:Organization
Organization Name:LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LAGATTUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-7361
Mailing Address - Street 1:218 N I ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-0909
Mailing Address - Country:US
Mailing Address - Phone:805-928-7361
Mailing Address - Fax:805-928-5742
Practice Address - Street 1:169 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4169
Practice Address - Country:US
Practice Address - Phone:503-477-8645
Practice Address - Fax:503-208-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty