Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 58397 | MN |
NPI | 1093954877 |
---|---|
Provider Name | Dr. Liana M. Lugo |
First Address | Saint Cloud, MN 56303-2255 |
Second Address | Saint Cloud, MN 56303-2255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 04/06/2015 |