Provider Demographics
NPI:1508438649
Name:SEMIDEI LUGO, FELIX IMANOL (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:IMANOL
Last Name:SEMIDEI LUGO
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:HC 3 BOX 15354
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9822
Mailing Address - Country:US
Mailing Address - Phone:787-718-9119
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SEVERIANO CUEVAS #18 KM 141.1 BO. CAIMITAL BAJO
Practice Address - Street 2:HOSPITAL BUEN SAMARITANO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15967-I208D00000X
PR390200000X
PR1043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program