Provider Demographics
NPI:1083497044
Name:LUGO SERRANO, JULIANNA
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:LUGO SERRANO
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:LA ALHAMBRA, REINA MORA STREET
Mailing Address - Street 2:2604
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-599-1106
Mailing Address - Fax:
Practice Address - Street 1:LA ALHAMBRA, REINA MORA STREET
Practice Address - Street 2:2604
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-599-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2865390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program