MEDICARE: LUBOV PATOUGA PA-C

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	363A00000X	Physician Assistant	51443	CA
2	363AM0700X	Medical Physician Assistant	51443	CA

General Provider Information

NPI Number	:	1932525219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBOV PATOUGA PA-C

Provider Business Mailing Address
First Line	:	1289 S PARK VICTORIA DR STE 200
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-6974
Country	:	US
Telephone Number	:	408-586-8866
Fax Number	:	408-586-8858

Provider Business Practice Location Address
First Line	:	1289 S PARK VICTORIA DR STE 200
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-6974
Country	:	US
Telephone Number	:	408-586-8866
Fax Number	:	408-586-8858

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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Directions to “ LUBOV PATOUGA PA-C” Practice Location

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