Provider Demographics
NPI:1801871785
Name:QUILES LUGO, MANUEL A (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:QUILES LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 19062
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1062
Mailing Address - Country:US
Mailing Address - Phone:787-723-4555
Mailing Address - Fax:787-721-5180
Practice Address - Street 1:CENTRO PLAZA BUILDING LLOVERAS ST
Practice Address - Street 2:STE 103
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-723-4555
Practice Address - Fax:787-721-5180
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8990207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81697OtherTRIPLE SSS
PR6320041OtherHUMANA HEALTH
PR067690OtherCRUZ AZUL
PR4537688OtherPLAN SALUD UIA
PR6320041OtherHUMANA INSURANCE
PR220106OtherPREFERRED HEALTH INSURANC
PR6320041OtherHUMANA INSURANCE
PR6320041OtherHUMANA HEALTH