Provider Demographics
NPI:1043270028
Name:RAMIREZ LUGO, OCTAVIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:A
Last Name:RAMIREZ LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 10083
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988
Mailing Address - Country:US
Mailing Address - Phone:787-750-1950
Mailing Address - Fax:787-750-1950
Practice Address - Street 1:923 CARMEN HERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-750-1950
Practice Address - Fax:787-750-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007643208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080025Medicare ID - Type Unspecified
PRC77759Medicare UPIN