Healthcare Provider Details

I. General information

NPI: 1376245019
Provider Name (Legal Business Name): FERNANDO A LUGO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 AVE BARBOSA
ARECIBO PR
00612-4329
US

IV. Provider business mailing address

URB. CIUDAD ATLANTIS 51 CALLE MIDAS
ARECIBO PR
00612-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-817-1818
  • Fax:
Mailing address:
  • Phone: 787-817-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25108
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: