Healthcare Provider Details

I. General information

NPI: 1699656538
Provider Name (Legal Business Name): SANDRA LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B20 CALLE MARIANA BRACETTI
CABO ROJO PR
00623-3349
US

IV. Provider business mailing address

B20 CALLE MARIANA BRACETTI
CABO ROJO PR
00623-3349
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4350
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: