Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 271059 | MA |
Y | 2084N0402X | Child Neurologist | A166670 | CA |
NPI | 1366881674 |
---|---|
Provider Name | Giancarlo J Lugo |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 08/07/2020 |