Provider Demographics
NPI:1427029255
Name:LAGO, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:LAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 9020458
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0458
Mailing Address - Country:US
Mailing Address - Phone:787-258-2835
Mailing Address - Fax:
Practice Address - Street 1:CALLE DEL PARQUE 240
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-0458
Practice Address - Country:US
Practice Address - Phone:787-258-2835
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21791Medicare ID - Type Unspecified
I12572Medicare UPIN