Provider Demographics
NPI:1336219849
Name:LUGO OLIVIERI, CARLOS HERNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:HERNAN
Last Name:LUGO OLIVIERI
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:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1019
Mailing Address - Country:US
Mailing Address - Phone:787-805-1552
Mailing Address - Fax:787-833-0715
Practice Address - Street 1:AVENIDA HOSTOS #410 , CARR 2
Practice Address - Street 2:BO. SABALOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-805-1552
Practice Address - Fax:787-652-9256
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73160Medicare UPIN
0084915Medicare ID - Type Unspecified