Provider Demographics
NPI:1689825952
Name:DR FABIO H LUGO GUTIERREZ CSP
Entity Type:Organization
Organization Name:DR FABIO H LUGO GUTIERREZ CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAMILET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-2594
Mailing Address - Street 1:309 TORRE SAN CRISTOBAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2856
Mailing Address - Country:US
Mailing Address - Phone:787-842-2594
Mailing Address - Fax:787-840-8821
Practice Address - Street 1:309 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2856
Practice Address - Country:US
Practice Address - Phone:787-842-2594
Practice Address - Fax:787-840-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8442261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center