Healthcare Provider Details

I. General information

NPI: 1629203195
Provider Name (Legal Business Name): ESMERALDA LUGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

IV. Provider business mailing address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-6500
  • Fax: 210-297-4165
Mailing address:
  • Phone: 210-297-6500
  • Fax: 210-297-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: