Healthcare Provider Details

I. General information

NPI: 1053385005
Provider Name (Legal Business Name): LUIS A. GUZMAN-LUGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA JUANITA AVENUE WP3
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 1616
BAYAMON PR
00960-1616
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-2608
  • Fax: 787-740-2612
Mailing address:
  • Phone: 787-740-2608
  • Fax: 787-740-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number13865
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: