Provider Demographics
NPI:1710454749
Name:LUGO RIVERA, AMILCAR EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:AMILCAR
Middle Name:EUGENIO
Last Name:LUGO RIVERA
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 1467
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1467
Mailing Address - Country:US
Mailing Address - Phone:787-644-4223
Mailing Address - Fax:
Practice Address - Street 1:340 AVE FELISA RINCON
Practice Address - Street 2:COND. PASEO DEL BOSQUE APT 2314
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-644-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021144208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice