Healthcare Provider Details

I. General information

NPI: 1083545149
Provider Name (Legal Business Name): LAURA A CRUZ LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

37 CALLE REGINA MEDINA APT C-802
GUAYNABO PR
00969-6001
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License Number6603
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: