Healthcare Provider Details

I. General information

NPI: 1245751791
Provider Name (Legal Business Name): TAMIKA SHAWN'TA LUGO CADCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE BLDG 3
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE BLDG 3
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-2105
  • Fax:
Mailing address:
  • Phone: 951-955-2105
  • Fax: 951-658-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: