Healthcare Provider Details

I. General information

NPI: 1528389822
Provider Name (Legal Business Name): LUGO-COLON & TOVANYAN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 RIVERSIDE DR STE 6
NORTH HOLLYWOOD CA
91602-1066
US

IV. Provider business mailing address

11650 RIVERSIDE DR STE 6
NORTH HOLLYWOOD CA
91602-1066
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-1221
  • Fax: 818-980-3221
Mailing address:
  • Phone: 818-980-1221
  • Fax: 818-980-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA107410
License Number StateCA

VIII. Authorized Official

Name: DR. HAROOT TOVANYAN
Title or Position: CFO
Credential: DC
Phone: 818-980-1221