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General NPI Number Information
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NPI Number | 1184111494
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Entity Type | Organization
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Legal Business Name | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1223 HIGUERA ST STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3167
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Country | US
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Telephone | 805-541-8581
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Fax |
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Provider Business Mailing Address
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Address Line | 218 N I ST
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City | LOMPOC
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State | CA
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Zip | 93436-0909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONTRACTS MANAGER
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Name | AMY D'AMATO
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Credential |
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Telephone | 805-264-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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