Provider Demographics
NPI:1699922104
Name:LUGO, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
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:PO BOX 4402
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-4402
Mailing Address - Country:US
Mailing Address - Phone:760-332-8844
Mailing Address - Fax:
Practice Address - Street 1:945 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4365
Practice Address - Country:US
Practice Address - Phone:760-332-8844
Practice Address - Fax:760-459-1762
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health