Provider Demographics
NPI:1356908610
Name:LUGO ALVAREZ, IDANIA
Entity type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:LUGO ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 45TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3970
Mailing Address - Country:US
Mailing Address - Phone:239-245-3066
Mailing Address - Fax:
Practice Address - Street 1:5245 RAMSEY WAY STE 5
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2124
Practice Address - Country:US
Practice Address - Phone:239-691-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty