Healthcare Provider Details

I. General information

NPI: 1356674808
Provider Name (Legal Business Name): MANUEL ENRIQUE LUGO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 AUTUMN BREEZE WAY
KISSIMMEE FL
34744-9273
US

IV. Provider business mailing address

2809 AUTUMN BREEZE WAY
KISSIMMEE FL
34744-9273
US

V. Phone/Fax

Practice location:
  • Phone: 407-497-3041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9100273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: