MEDICARE: MS. ROSALVA LUGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1871753798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSALVA LUGO

Provider Business Mailing Address
First Line	:	9150 IMPERIAL HWY
Second Line	:	ROOM P-31
City	:	DOWNEY
State	:	CA
Zip	:	90242-2835
Country	:	US
Telephone Number	:	562-940-3694
Fax Number	:	562-435-8523

Provider Business Practice Location Address
First Line	:	415 W OCEAN BLVD
Second Line	:	#100
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4512
Country	:	US
Telephone Number	:	562-491-5807
Fax Number	:	562-435-8523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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Directions to “ MS. ROSALVA LUGO ” Practice Location

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