1912300617 NPI number — LISBETH LUGO SR

Table of content: (NPI 1912300617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912300617 NPI number — LISBETH LUGO SR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISBETH LUGO SR
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:
6
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:
1912300617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 6211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-9741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-216-9287
Provider Business Mailing Address Fax Number:
787-848-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 116 KM 24.7
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL PLAZA GUANICA SUITE 6 BO CANO
Provider Business Practice Location Address City Name:
GUANICA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-216-9287
Provider Business Practice Location Address Fax Number:
787-848-0318
Provider Enumeration Date:
10/08/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUGO NIEVES
Authorized Official First Name:
LISBETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SUPERVISOR
Authorized Official Telephone Number:
787-216-9287

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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)