Healthcare Provider Details

I. General information

NPI: 1124954136
Provider Name (Legal Business Name): TANIA GONZALEZ LUGO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 E EMMA AVE STE 300
SPRINGDALE AR
72764-4469
US

IV. Provider business mailing address

6307 SW HERITAGE AVE
BENTONVILLE AR
72713-5187
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-7417
  • Fax:
Mailing address:
  • Phone: 479-685-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: