Healthcare Provider Details

I. General information

NPI: 1871051128
Provider Name (Legal Business Name): CARLOS EDUARDO ANTONIO RUIZ LUGO SR. ENFERMERO RN, WCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CABO ROJO URB MANSIONES DE CABO ROJO PALMAS
CABO ROJO PR
00623-8933
US

IV. Provider business mailing address

80 CABO ROJO URB MANSIONES DE CABO ROJO PALMAS
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-398-2164
  • Fax: 787-255-1846
Mailing address:
  • Phone: 787-398-2164
  • Fax: 787-255-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number075971
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number075971
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number075971
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number078971
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: