Healthcare Provider Details

I. General information

NPI: 1215031547
Provider Name (Legal Business Name): JORGE I. RODRIGUEZ LUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MED SAN LUCAS 5TO PISO OFICINA 508
PONCE PR
00716-4728
US

IV. Provider business mailing address

609 AVE TITO CASTRO SUITE 102 PMB 464
PONCE PR
00716-2232
US

V. Phone/Fax

Practice location:
  • Phone: 787-385-8200
  • Fax:
Mailing address:
  • Phone: 787-385-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number14399
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14399
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: