Healthcare Provider Details

I. General information

NPI: 1588652085
Provider Name (Legal Business Name): CARMELO EDUARDO HERRERO LUGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CALLE MUNOZ MARIN
HUMACAO PR
00791-3646
US

IV. Provider business mailing address

59 CALLE MUNOZ MARIN
HUMACAO PR
00791-3646
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-2100
  • Fax: 787-719-6533
Mailing address:
  • Phone: 787-852-2100
  • Fax: 787-719-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14460
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: