Provider Demographics
NPI:1093292195
Name:LUGO MORALES, FAUSTO CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:FAUSTO
Middle Name:CARLOS
Last Name:LUGO MORALES
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:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0560
Mailing Address - Country:US
Mailing Address - Phone:787-851-5238
Mailing Address - Fax:
Practice Address - Street 1:48B CALLE SALVADOR BRAU
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3458
Practice Address - Country:US
Practice Address - Phone:787-851-5238
Practice Address - Fax:787-652-4278
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22093208D00000X
PR14694-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program