Individual
OLIVIA LUGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT, BEAUTICIAN
Contact information
Practice address
1901 STANDIFORD AVE, MODESTO, CA 95350-0149
(209) 402-8211
Mailing address
3204 JANET CIR, MODESTO, CA 95350-0413
(209) 571-1940
Taxonomy
Speciality
Code
Description
License number
State
175L00000X
Homeopath
Primary
BG06149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175F00000X
CMT, BEAUTICIAN
CA
Enumeration date
03/21/2007
Last updated
07/08/2007
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