Provider Demographics
NPI:1700082336
Name:LUGO-SANTIAGO, DIANA IRIS (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:IRIS
Last Name:LUGO-SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1033
Mailing Address - Country:US
Mailing Address - Phone:787-895-3372
Mailing Address - Fax:787-819-0285
Practice Address - Street 1:DEPT. OF HEALTH SEVERIANO CUEVAS AVE
Practice Address - Street 2:APARTMENT #3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00604
Practice Address - Country:US
Practice Address - Phone:787-891-8600
Practice Address - Fax:787-819-0285
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78732083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine