Healthcare Provider Details

I. General information

NPI: 1417252735
Provider Name (Legal Business Name): LAGS SPINE & SPORTSCARE MEDICAL CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 S 13TH ST
GROVER BEACH CA
93433-3820
US

IV. Provider business mailing address

135 CARMEN LN
SANTA MARIA CA
93458-7729
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 TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG84334
License Number StateCA

VIII. Authorized Official

Name: FRANCIS P LAGATTUTA
Title or Position: PRESIDENT
Credential: MS
Phone: 805-928-7361