Provider Demographics
NPI:1164693198
Name:CENTRO DE VACUNACION DR. ADALBERTO LUGO
Entity Type:Organization
Organization Name:CENTRO DE VACUNACION DR. ADALBERTO LUGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO BONETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-829-2023
Mailing Address - Street 1:JOAQUIN ANDINO 14 C ST
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601
Mailing Address - Country:US
Mailing Address - Phone:787-829-2023
Mailing Address - Fax:787-829-2569
Practice Address - Street 1:JOAQUIN ANDINO 14 C ST
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601
Practice Address - Country:US
Practice Address - Phone:787-829-2023
Practice Address - Fax:787-829-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6266261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27215OtherSSS PROVIDER ID