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General NPI Number Information
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NPI Number | 1972572519
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Entity Type | Individual
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Provider Name | EDWIN I LUGO LUGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 1 CARR 21 LAS LOMAS
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City | RIO PIEDRAS
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State | PR
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Zip | 00926-2609
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Country | US
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Telephone | 787-782-8055
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Fax | 787-782-7780
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Provider Business Mailing Address
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Address Line | 441 CALLE SAN LEANDRO SAGRADO CORAZON
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City | SAN JUAN
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State | PR
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Zip | 00926-4216
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Country | US
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Telephone | 787-782-8055
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Fax | 787-782-7780
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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 | 9703
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License Number State | PR
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