Provider Demographics
NPI:1013762954
Name:LUGO RODRIGUEZ, ISMAEL ENRIQUE
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:ENRIQUE
Last Name:LUGO RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CALLE GARDENIA
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4561
Mailing Address - Country:US
Mailing Address - Phone:787-324-1752
Mailing Address - Fax:
Practice Address - Street 1:CARR. 172
Practice Address - Street 2:URB.TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program