Healthcare Provider Details

I. General information

NPI: 1588598338
Provider Name (Legal Business Name): MARIAM LUGO NOGUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 PEPPER BERRY LN APT 4576
HILLIARD OH
43026-1954
US

IV. Provider business mailing address

4576 PEPPER BERRY LN APT 4576
HILLIARD OH
43026-1954
US

V. Phone/Fax

Practice location:
  • Phone: 713-637-9714
  • Fax:
Mailing address:
  • Phone: 713-637-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number005043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: