Healthcare Provider Details

I. General information

NPI: 1487998787
Provider Name (Legal Business Name): CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 PONCE BY PASS SUITE 205 EDIFICIO CENTRO CARIBE
PONCE PR
00717-1308
US

IV. Provider business mailing address

PO BOX 712
MERCEDITA PR
00715-0712
US

V. Phone/Fax

Practice location:
  • Phone: 787-315-7917
  • Fax:
Mailing address:
  • Phone: 787-315-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number10613
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS JORGE LUGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-315-7917