1306978879 NPI number — JAVIER ISMAEL LUGO DE JESUS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306978879 NPI number — JAVIER ISMAEL LUGO DE JESUS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUGO DE JESUS
Provider First Name:
JAVIER
Provider Middle Name:
ISMAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUGO DE JESUS
Provider Other First Name:
JAVIER
Provider Other Middle Name:
ISMAEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306978879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7436
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-7436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-652-4864
Provider Business Mailing Address Fax Number:
787-652-4865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 AVE. HOSTOS
Provider Second Line Business Practice Location Address:
MEDICAL CENTER PLAZA, SUITE 305
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-652-4864
Provider Business Practice Location Address Fax Number:
787-652-4865
Provider Enumeration Date:
03/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  16272 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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