Healthcare Provider Details

I. General information

NPI: 1235474826
Provider Name (Legal Business Name): MICHELE LUGO-CALLE BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 W FLAGLER ST
CORAL GABLES FL
33134-1604
US

IV. Provider business mailing address

6100 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-3334
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: