Provider Demographics
NPI:1013102508
Name:GONZALEZ-LUGO, CARLOS M (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:GONZALEZ-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 1:205 CALLE SAN JUSTO
Mailing Address - Street 2:APT. 2A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1710
Mailing Address - Country:US
Mailing Address - Phone:787-724-0017
Mailing Address - Fax:
Practice Address - Street 1:205 CALLE SAN JUSTO
Practice Address - Street 2:APT. 2A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1710
Practice Address - Country:US
Practice Address - Phone:787-724-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14114208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice