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Organization
LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Active
Organization
LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY D'AMATO (CONTRACTS MANAGER)
(805) 264-3388
Entity
Organization
Contact information
Practice address
4505 PRECISSI LN STE A, STOCKTON, CA 95207-6240
(209) 425-3815
(209) 451-0704
Mailing address
218 N I ST, LOMPOC, CA 93436-0909
(805) 736-7886
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
NULL
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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