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General NPI Number Information
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NPI Number | 1861681975
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Entity Type | Organization
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Legal Business Name | VICTOR LUGO MIRO MD PA
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 3036 NORTHPARK DR
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City | KINGWOOD
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State | TX
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Zip | 77339-5114
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Country | US
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Telephone | 281-360-8501
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Fax | 281-360-8617
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Provider Business Mailing Address
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Address Line | 3036 NORTHPARK DR
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City | KINGWOOD
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State | TX
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Zip | 77339-5114
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Country | US
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Telephone | 281-360-8501
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Fax | 281-360-8617
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. VICTOR I LUGO MIRO SR.
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Credential | M.D.
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Telephone | 281-360-8501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H6890
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H6890
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License Number State | TX
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