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General NPI Number Information
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NPI Number | 1548455660
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Entity Type | Individual
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Provider Name | KHRISTOPHER MICHAEL LUGO P.A.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 3644 HENDERSON BLVD STE B
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City | TAMPA
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State | FL
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Zip | 33609
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Country | US
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Telephone | 844-789-2266
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Fax | 813-260-2411
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Provider Business Mailing Address
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Address Line | 3644 HENDERSON BLVD STE B
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City | TAMPA
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State | FL
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Zip | 33609-4502
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Country | US
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Telephone | 844-789-2266
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Fax | 813-260-2411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 100638
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9101888
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101888
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License Number State | FL
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