1467770487 NPI number — MR. ISRAEL LUGO JR. TEM

Table of content: MR. ISRAEL LUGO JR. TEM (NPI 1467770487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467770487 NPI number — MR. ISRAEL LUGO JR. TEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUGO
Provider First Name:
ISRAEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
TEM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUGO
Provider Other First Name:
ISRAEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
TEM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467770487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COM LAS MARIAS 455 CALLE LUIS MUNOZ MARIN
Provider Second Line Business Mailing Address:
RR 2 BOX 3358
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-988-9793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COM LAS MARIAS 455 CALLE LUIS MUNOZ MARIN
Provider Second Line Business Practice Location Address:
RR 2 BOX 3358
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-988-9793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2010

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: 146L00000X , with the licence number:  PP , 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)