Provider Demographics
NPI:1215031547
Name:RODRIGUEZ LUGO, JORGE I (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:I
Last Name:RODRIGUEZ 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 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 464
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2232
Mailing Address - Country:US
Mailing Address - Phone:787-385-8200
Mailing Address - Fax:
Practice Address - Street 1:TORRE MED SAN LUCAS
Practice Address - Street 2:5TO PISO OFICINA 508
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-385-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X
PR14399261QX0200X, 207RH0003X, 2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital