Provider Demographics
NPI:1891380358
Name:PERDOMO LUGO, RONAL (SA-C)
Entity Type:Individual
Prefix:
First Name:RONAL
Middle Name:
Last Name:PERDOMO LUGO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 NW 7TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2152
Mailing Address - Country:US
Mailing Address - Phone:502-608-6694
Mailing Address - Fax:
Practice Address - Street 1:8500 SW 8TH ST STE 246
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4000
Practice Address - Country:US
Practice Address - Phone:305-262-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-150246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty