Healthcare Provider Details

I. General information

NPI: 1124816988
Provider Name (Legal Business Name): DARIA MICHELLE LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W PERSHING RD STE 403
KANSAS CITY MO
64108-4305
US

IV. Provider business mailing address

215 W PERSHING RD STE 403
KANSAS CITY MO
64108-4305
US

V. Phone/Fax

Practice location:
  • Phone: 785-429-4767
  • Fax: 816-207-0639
Mailing address:
  • Phone: 785-429-4767
  • Fax: 816-207-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: