Healthcare Provider Details

I. General information

NPI: 1184027856
Provider Name (Legal Business Name): LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 COLLEGE AVE UNIT A
BERKELEY CA
94705-2167
US

IV. Provider business mailing address

801 E CHAPEL ST STE. 1
SANTA MARIA CA
93454-4607
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7361
  • Fax:
Mailing address:
  • Phone: 805-928-7361
  • Fax: 805-928-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS P LAGATTUTA
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: M.D.
Phone: 805-928-7361