Healthcare Provider Details

I. General information

NPI: 1801203161
Provider Name (Legal Business Name): LOUGEL BARRUGA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 FIRESTONE BLVD
DOWNEY CA
90241-4100
US

IV. Provider business mailing address

1735 N AVENUE 53
LOS ANGELES CA
90042-1101
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax:
Mailing address:
  • Phone: 323-695-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: