Provider Demographics
NPI:1417145731
Name:GARCIA LUGO, MAGDALENA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:GARCIA LUGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 CALLE TRAPICHE
Mailing Address - Street 2:HACIENDA LA MATILDE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2425
Mailing Address - Country:US
Mailing Address - Phone:787-317-0807
Mailing Address - Fax:
Practice Address - Street 1:5148 CALLE TRAPICHE
Practice Address - Street 2:HACIENDA LA MATILDE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2425
Practice Address - Country:US
Practice Address - Phone:787-317-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014631163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse