Provider Demographics
NPI:1518064872
Name:LUGO CARMONA, LILLIAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAM
Middle Name:D
Last Name:LUGO CARMONA
Suffix:
Gender:F
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 256
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0256
Mailing Address - Country:US
Mailing Address - Phone:787-866-8412
Mailing Address - Fax:
Practice Address - Street 1:COMMERCE PLAZA 202
Practice Address - Street 2:URB COSTA AZUL
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-866-0708
Practice Address - Fax:787-866-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14027208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021823Medicare ID - Type UnspecifiedMEDICARE ID