Provider Demographics
NPI:1912300617
Name:LISBETH LUGO SR
Entity Type:Organization
Organization Name:LISBETH LUGO SR
Other - Org Name:LABORATORIO CLINICO LA 116
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-216-9287
Mailing Address - Street 1:HC 1 BOX 6211
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9741
Mailing Address - Country:US
Mailing Address - Phone:787-216-9287
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:CARR 116 KM 24.7
Practice Address - Street 2:CENTRO COMERCIAL PLAZA GUANICA SUITE 6 BO CANO
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653
Practice Address - Country:US
Practice Address - Phone:787-216-9287
Practice Address - Fax:787-848-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory