Healthcare Provider Details

I. General information

NPI: 1821028929
Provider Name (Legal Business Name): SONIA NOEMI LUGO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 NW 123RD WAY
CORAL SPRINGS FL
33065-8011
US

IV. Provider business mailing address

2646 NW 123RD WAY
CORAL SPRINGS FL
33065-8011
US

V. Phone/Fax

Practice location:
  • Phone: 954-345-8827
  • Fax: 954-345-8827
Mailing address:
  • Phone: 954-345-8827
  • Fax: 954-345-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA43384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: