Provider Demographics
NPI:1639230238
Name:LUGO, MARIA TERESA
Entity type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:LUGO
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:EL BOSQUE
Mailing Address - Street 2:APT.1305
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-272-2728
Mailing Address - Fax:
Practice Address - Street 1:EL BOSQUE
Practice Address - Street 2:APT.1305
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-272-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist