Healthcare Provider Details

I. General information

NPI: 1114127404
Provider Name (Legal Business Name): MIRIAN DOLORES LUGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S STATE ROAD 7 STE 109
WELLINGTON FL
33449-8099
US

IV. Provider business mailing address

3319 S STATE ROAD 7 STE 109
WELLINGTON FL
33449-8099
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-5437
  • Fax: 561-798-7726
Mailing address:
  • Phone: 561-798-5437
  • Fax: 561-798-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME148908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: