Healthcare Provider Details

I. General information

NPI: 1013491521
Provider Name (Legal Business Name): LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N I ST
LOMPOC CA
93436-0909
US

IV. Provider business mailing address

218 N I ST
LOMPOC CA
93436-0909
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-7886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FRANCIS P LAGATTUTA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 805-925-9581