Provider Demographics
NPI:1427535632
Name:LUGO MENENDEZ, MARTIN ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ENRIQUE
Last Name:LUGO MENENDEZ
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 1:30 CALLE MALVA APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6631
Mailing Address - Country:US
Mailing Address - Phone:787-348-5212
Mailing Address - Fax:
Practice Address - Street 1:STATE RD 877 KM 1.6
Practice Address - Street 2:CAMINO LAS LOMAS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-625-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023446208D00000X
PR16117-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice