Provider Demographics
NPI:1528030533
Name:JUSINO LUGO, PERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERLY
Middle Name:
Last Name:JUSINO LUGO
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 3159
Mailing Address - Street 2:HATO ARRIBA STATION
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7003
Mailing Address - Country:US
Mailing Address - Phone:787-265-2214
Mailing Address - Fax:
Practice Address - Street 1:BO. MANI CARR 64
Practice Address - Street 2:BOX 5130
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-265-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020530Medicare ID - Type Unspecified
PRH55682Medicare UPIN