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General NPI Number Information
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NPI Number | 1619166824
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Entity Type | Individual
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Provider Name | RAUL A ORTIZ LUGO AUDIOLOGO
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Gender | Male
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | AVE ATLETICOS DE SAN GERMAN EDIFICIO RALI SUITE 204
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City | SAN GERMAN
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State | PR
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Zip | 00683-9800
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Country | US
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Telephone | 787-264-7027
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Fax | 787-264-7027
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Provider Business Mailing Address
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Address Line | PO BOX 5000 PMB 477
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City | SAN GERMAN
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State | PR
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Zip | 00683-9800
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Country | US
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Telephone | 787-264-7027
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Fax | 787-264-7027
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 450
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License Number State | PR
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