1225394679 NPI number — LIZBETTE LUGO PEREZ CSP

Table of content: DR. MATTHEW DOUGLAS HAMILTON D.C. (NPI 1306996178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225394679 NPI number — LIZBETTE LUGO PEREZ CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIZBETTE LUGO PEREZ CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225394679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1373
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-1373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-342-6120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA HOSPITAL, CALLE TRINA PADILLA # 406
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-342-6120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUGO
Authorized Official First Name:
LIZBETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
787-342-6120

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  18074 , 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)