Healthcare Provider Details

I. General information

NPI: 1700939543
Provider Name (Legal Business Name): LOURDES GARRIGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AGUAS BUENAS BLO10#15 URB SANTA RNA
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 8401
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-3151
  • Fax: 787-785-3254
Mailing address:
  • Phone: 787-785-3151
  • Fax: 787-785-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12645
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: