Provider Demographics
NPI:1164423828
Name:LUGO, LIONEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:
Last Name: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:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1063
Mailing Address - Country:US
Mailing Address - Phone:787-848-4777
Mailing Address - Fax:787-848-4777
Practice Address - Street 1:HOSPITAL SAN LUCAS I
Practice Address - Street 2:CALLE GUADALUPE FINAL - BOX 2027
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-848-4777
Practice Address - Fax:787-848-4777
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0097990Medicare ID - Type Unspecified