Provider Demographics
NPI:1164057261
Name:LUGO, FELICITA DESIREE (MD, ME, PATH/TOX)
Entity Type:Individual
Prefix:DR
First Name:FELICITA
Middle Name:DESIREE
Last Name:LUGO
Suffix:
Gender:F
Credentials:MD, ME, PATH/TOX
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 50997
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0308
Mailing Address - Country:US
Mailing Address - Phone:941-921-2225
Mailing Address - Fax:941-927-8234
Practice Address - Street 1:3436 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7260
Practice Address - Country:US
Practice Address - Phone:941-921-2225
Practice Address - Fax:941-927-8234
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8996111N00000X
FLME139133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009692200Medicaid