Healthcare Provider Details

I. General information

NPI: 1962082065
Provider Name (Legal Business Name): MS. VALERIA CRISTINA LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S GRAND AVE
COVINA CA
91724-3464
US

IV. Provider business mailing address

400 S GRAND AVE
COVINA CA
91724-3464
US

V. Phone/Fax

Practice location:
  • Phone: 323-426-6402
  • Fax:
Mailing address:
  • Phone: 323-426-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: