Provider Demographics
NPI:1265491948
Name:LUGO OLIVIERI, HERNAN III (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:HERNAN III
Middle Name:
Last Name:LUGO OLIVIERI
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ROAD LAS PALMAS WARD KM 12.4
Mailing Address - Street 2:PMB 315 PO BOX 5103-315
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-910-5399
Mailing Address - Fax:
Practice Address - Street 1:303 ROAD LAS PALMAS WARD KM.12.4
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-910-5399
Practice Address - Fax:787-910-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH93175Medicare UPIN