Healthcare Provider Details

I. General information

NPI: 1265418735
Provider Name (Legal Business Name): VERONICA A LUGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDANT CG/1122 2100 SECOND ST. SW SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

1916 FERDINAND ST
CORAL GABLES FL
33134-2153
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6610
  • Fax: 609-898-6962
Mailing address:
  • Phone: 352-274-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: