Provider Demographics
NPI:1376430645
Name:MK LOTUS MEDICAL LLC
Entity type:Organization
Organization Name:MK LOTUS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MPH, APRN, FNP-
Authorized Official - Phone:323-904-2408
Mailing Address - Street 1:182 FLORES ROSA LOOP
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1247
Mailing Address - Country:US
Mailing Address - Phone:323-904-2408
Mailing Address - Fax:
Practice Address - Street 1:182 FLORES ROSA LOOP
Practice Address - Street 2:
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913-1247
Practice Address - Country:US
Practice Address - Phone:323-904-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty