Healthcare Provider Details

I. General information

NPI: 1104235688
Provider Name (Legal Business Name): ALEJANDRA LUGO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 COLORADO AVE
TURLOCK CA
95382-2714
US

IV. Provider business mailing address

1739 COLORADO AVE
TURLOCK CA
95382-2714
US

V. Phone/Fax

Practice location:
  • Phone: 209-448-3000
  • Fax:
Mailing address:
  • Phone: 209-448-3000
  • Fax: 209-442-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number790538
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number85719
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: