Healthcare Provider Details

I. General information

NPI: 1366321713
Provider Name (Legal Business Name): IRVIN JOEL SANTIAGO LUGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9975
CAROLINA PR
00988-9975
US

IV. Provider business mailing address

PO BOX 9975
CAROLINA PR
00988-9975
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-5374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number74610
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: