Provider Demographics
NPI:1972572519
Name:LUGO LUGO, EDWIN I (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:I
Last Name:LUGO LUGO
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 1:441 CALLE SAN LEANDRO
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4216
Mailing Address - Country:US
Mailing Address - Phone:787-782-8055
Mailing Address - Fax:787-782-7780
Practice Address - Street 1:1 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-2609
Practice Address - Country:US
Practice Address - Phone:787-782-8055
Practice Address - Fax:787-782-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE33824Medicare UPIN
PR81767Medicare ID - Type Unspecified