Provider Demographics
NPI:1710479647
Name:LUGO, WILFREDO SR
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:LUGO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 W 41ST ST APT 302
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5986
Mailing Address - Country:US
Mailing Address - Phone:786-280-2972
Mailing Address - Fax:
Practice Address - Street 1:1470 W 41ST ST APT 302
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5986
Practice Address - Country:US
Practice Address - Phone:786-280-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty