Individual
LUISA JOSEFINA LUGO GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3006 MARTA CIR APT 102, KISSIMMEE, FL 34741-0745
(407) 617-1953
Mailing address
3006 MARTA CIR APT 102, KISSIMMEE, FL 34741-0745
(407) 617-1953
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L225530586430
DRIVERS LICENSE
FL
Enumeration date
01/03/2019
Last updated
01/03/2019
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