Healthcare Provider Details

I. General information

NPI: 1790076990
Provider Name (Legal Business Name): FERDINAND LUGO ROMEU, PERIODONTIST, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT SUITE 615 LA TORRE DE PLAZA
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

PO BOX 361181
SAN JUAN PR
00936-1181
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-1233
  • Fax: 787-753-0299
Mailing address:
  • Phone: 787-767-1233
  • Fax: 787-753-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number842
License Number StatePR

VIII. Authorized Official

Name: DR. FERDINAND LUGO ROMEU
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 787-767-1233