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General NPI Number Information
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NPI Number | 1801866322
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Entity Type | Individual
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Provider Name | RAUL NELSON LUGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 2421 W 21ST ST STE B
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 757-697-5775
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Fax | 575-742-7856
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 575-769-7577
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2022-1422
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License Number State | NM
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