Healthcare Provider Details

I. General information

NPI: 1790267730
Provider Name (Legal Business Name): LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPEL ST STE 2
SANTA MARIA CA
93454-4607
US

IV. Provider business mailing address

218 NORTH I STREET
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-354-0073
  • Fax:
Mailing address:
  • Phone: 805-928-7361
  • 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

VIII. Authorized Official

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