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General NPI Number Information
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NPI Number | 1487998787
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Entity Type | Organization
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Legal Business Name | CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 2053 PONCE BY PASS SUITE 205 EDIFICIO CENTRO CARIBE
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City | PONCE
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State | PR
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Zip | 00717-1308
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Country | US
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Telephone | 787-315-7917
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 712
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City | MERCEDITA
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State | PR
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Zip | 00715-0712
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Country | US
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Telephone | 787-315-7917
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS JORGE LUGO
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Credential | M.D.
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Telephone | 787-315-7917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 10613
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License Number State | PR
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