Provider Demographics
NPI:1992876643
Name:LGLO, LLC
Entity type:Organization
Organization Name:LGLO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-806-8121
Mailing Address - Street 1:550 W VISTA WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5707
Mailing Address - Country:US
Mailing Address - Phone:760-945-4708
Mailing Address - Fax:760-945-9708
Practice Address - Street 1:550 W VISTA WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5707
Practice Address - Country:US
Practice Address - Phone:760-945-4708
Practice Address - Fax:760-945-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5016420001Medicare NSC