Healthcare Provider Details

I. General information

NPI: 1770134405
Provider Name (Legal Business Name): SONILYN LUGO-RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DOMENECH AVENUE BALDRICH
SAN JUAN PR
00918-3500
US

IV. Provider business mailing address

44 CALLE ASTARTE ALTO APOLO
GUAYNABO PR
00969-4943
US

V. Phone/Fax

Practice location:
  • Phone: 787-472-9011
  • Fax:
Mailing address:
  • Phone: 787-472-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number21542
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number21542
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21542
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: