Provider Demographics
NPI:1366252926
Name:LUGO, BROOKE RAE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:RAE
Last Name:LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 CROOKED STICK LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0616
Mailing Address - Country:US
Mailing Address - Phone:951-264-3567
Mailing Address - Fax:
Practice Address - Street 1:765 N MAIN ST STE 127
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-1440
Practice Address - Country:US
Practice Address - Phone:951-751-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool