Basic Information
| Provider Information | |||||||||
| NPI: | 1184938359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIAN LUGO, M.D., MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50187 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911150187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267684415 | ||||||||
| FaxNumber: | 6267684421 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 ALESSANDRO PL | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267684415 | ||||||||
| FaxNumber: | 6267684421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2010 | ||||||||
| LastUpdateDate: | 07/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | LUGO | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6267684415 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | A 87704 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | A 87704 | 01 | CA | MEDICAL LICENSE | OTHER |