Provider Demographics
NPI:1346252343
Name:LUGO PADUA, JOSE L
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:LUGO PADUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CALLE 2
Mailing Address - Street 2:GARDEN HILLS ESTATES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2907
Mailing Address - Country:US
Mailing Address - Phone:787-793-0153
Mailing Address - Fax:
Practice Address - Street 1:A9 CALLE 7
Practice Address - Street 2:BAYAMON GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2517
Practice Address - Country:US
Practice Address - Phone:787-797-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice