Healthcare Provider Details

I. General information

NPI: 1285848143
Provider Name (Legal Business Name): CARMELITA JASMINE LUGUE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 ABERDEEN BLVD STE A
GASTONIA NC
28054-0637
US

IV. Provider business mailing address

2680 ABERDEEN BLVD STE A
GASTONIA NC
28054-0637
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-2229
  • Fax: 704-865-2811
Mailing address:
  • Phone: 704-865-2229
  • Fax: 704-865-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2007-00607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: