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General NPI Number Information
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NPI Number | 1689825952
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Entity Type | Organization
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Legal Business Name | DR FABIO H LUGO GUTIERREZ CSP
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 309 TORRE SAN CRISTOBAL
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City | COTO LAUREL
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State | PR
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Zip | 00780-2856
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Country | US
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Telephone | 787-842-2594
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Fax | 787-840-8821
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Provider Business Mailing Address
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Address Line | 309 TORRE SAN CRISTOBAL
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City | COTO LAUREL
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State | PR
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Zip | 00780-2856
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Country | US
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Telephone | 787-842-2594
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Fax | 787-840-8821
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. YAMILET ROQUE
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Credential |
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Telephone | 787-842-2594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 8442
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License Number State | PR
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