Healthcare Provider Details

I. General information

NPI: 1316630130
Provider Name (Legal Business Name): NELI LIZBETH LUGO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 ANDERSON MILL RD
AUSTIN TX
78750-2400
US

IV. Provider business mailing address

14201 N INTERSTATE 35
PFLUGERVILLE TX
78660-4846
US

V. Phone/Fax

Practice location:
  • Phone: 512-640-7778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: