Provider Demographics
NPI:1801634076
Name:LUGO, BRIGETTE JO
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:JO
Last Name:LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 ELDERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-6093
Mailing Address - Country:US
Mailing Address - Phone:805-750-3435
Mailing Address - Fax:
Practice Address - Street 1:338 S DAKOTA AVE BLDG 13850
Practice Address - Street 2:
Practice Address - City:VANDENBERG AFB
Practice Address - State:CA
Practice Address - Zip Code:93437-6307
Practice Address - Country:US
Practice Address - Phone:805-606-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22327124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist