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General NPI Number Information
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NPI Number | 1194917872
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Entity Type | Individual
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Provider Name | JARDIEL FERDINAND LUGO CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 214-772-6397
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 COLE AVE APT 201 URB. SAN JOSE
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City | DALLAS
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State | TX
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Zip | 75205-3561
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Country | US
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Telephone | 214-772-6397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 739539
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License Number State | TX
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