Provider Demographics
NPI:1982798872
Name:RIVERA LUGO, CARLOS ENRIQUE (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:RIVERA LUGO
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 1003
Mailing Address - Street 2:PATROTA POZO #2
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-6393
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE ACOSTA
Practice Address - Street 2:ACOSTA #2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5256
Practice Address - Country:US
Practice Address - Phone:787-854-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCE2910Medicare UPIN