Provider Demographics
NPI:1932213691
Name:RIVERA LUGO, ENRIQUE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
Last Name:RIVERA LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1176
Mailing Address - Country:US
Mailing Address - Phone:787-746-4843
Mailing Address - Fax:787-258-0750
Practice Address - Street 1:D1 CALLE BALDORIOTY
Practice Address - Street 2:URB. PARADIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2655
Practice Address - Country:US
Practice Address - Phone:787-746-4843
Practice Address - Fax:787-258-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67032081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08764Medicare UPIN
98269Medicare ID - Type Unspecified