Provider Demographics
NPI:1437166188
Name:LUGO RODRIGUEZ, FAUSTO C (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:C
Last Name:LUGO RODRIGUEZ
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:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0786
Mailing Address - Country:US
Mailing Address - Phone:787-851-5238
Mailing Address - Fax:787-851-9054
Practice Address - Street 1:CALLE RUIZ BELVIS ESQUINA BARBOSA
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:787-851-5238
Practice Address - Fax:787-851-9054
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6466LU207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08348Medicare UPIN
25886LUMedicare ID - Type Unspecified