Provider Demographics
NPI:1972106367
Name:LUGO MORALES, NIXZALIZ (SLP)
Entity Type:Individual
Prefix:
First Name:NIXZALIZ
Middle Name:
Last Name:LUGO MORALES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 7 BOX 75941
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7324
Mailing Address - Country:US
Mailing Address - Phone:787-636-0064
Mailing Address - Fax:
Practice Address - Street 1:CARR 423 KM 1.7
Practice Address - Street 2:BO HATO ARRIBA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-636-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist