Healthcare Provider Details

I. General information

NPI: 1093347015
Provider Name (Legal Business Name): CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 PONCE BYPASS CENTRO CARIBE BLDG. SUITE 205
PONCE PR
00730
US

IV. Provider business mailing address

PO BOX 712
MERCEDITA PR
00715-0712
US

V. Phone/Fax

Practice location:
  • Phone: 787-987-8050
  • Fax:
Mailing address:
  • Phone: 787-987-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS JORGE LUGO VELEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-688-7327