Healthcare Provider Details

I. General information

NPI: 1083835243
Provider Name (Legal Business Name): PEDRO LUGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 109, KM. 5.3 BO ESPINO
ANASCO PR
00610
US

IV. Provider business mailing address

RR 3 BUZON 10807
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-2525
  • Fax: 787-818-0429
Mailing address:
  • Phone: 787-826-2525
  • Fax: 787-818-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC AMB 424
License Number StatePR

VIII. Authorized Official

Name: PEDRO LUGO
Title or Position: OWNER
Credential:
Phone: 787-826-2525