Provider Demographics
NPI:1982669750
Name:LUGO DELGADO, ETTIENNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ETTIENNE
Middle Name:
Last Name:LUGO DELGADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4 CALLE HOLLYWOOD DRIVE
Mailing Address - Street 2:URB. HOLLYWOOD ESTATES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-262-1486
Mailing Address - Fax:787-262-1486
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 5
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0000
Practice Address - Country:US
Practice Address - Phone:787-262-1486
Practice Address - Fax:787-262-1486
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist