MEDICARE: ELYETTE M LUGO BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	MD
3	390200000X	Student in an Organized Health Care Education/Training Program	PR

General Provider Information

NPI Number	:	1134013840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYETTE M LUGO BS

Provider Business Mailing Address
First Line	:	929 N WOLFE ST UNIT 313
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1137
Country	:	US
Telephone Number	:	787-430-9695
Fax Number	:

Provider Business Practice Location Address
First Line	:	CLL 297 BORINQUEN GARDENS LEOPOLDO RUMANACH
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-430-9695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	04/02/2026

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Directions to “ ELYETTE M LUGO BS” Practice Location

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