1851968036 NPI number — LILYBETH D. LUGO MONTALVO AU.D.

Table of content: LILYBETH D. LUGO MONTALVO AU.D. (NPI 1851968036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851968036 NPI number — LILYBETH D. LUGO MONTALVO AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUGO MONTALVO
Provider First Name:
LILYBETH
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

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:
1851968036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. ESTANCIAS DEL GOLF #504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730-5762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-316-0075
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 CALLE SALVADOR BRAU 154
Provider Second Line Business Practice Location Address:
HOSPITAL MUNICIPAL MARIANO RIVERA RAMOS
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-705-9060
Provider Business Practice Location Address Fax Number:
787-965-5404
Provider Enumeration Date:
06/07/2021

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: 231H00000X , 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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