MEDICARE: MARIE C. LUGO CRUZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1649916321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIE C. LUGO CRUZ

Provider Business Mailing Address
First Line	:	P.O. BOX 197
Second Line	:
City	:	LA PLATA
State	:	PR
Zip	:	00786-0197
Country	:	US
Telephone Number	:	787-590-4963
Fax Number	:	787-735-2536

Provider Business Practice Location Address
First Line	:	1-99 CALLE JOSE C. VAZQUEZ
Second Line	:
City	:	AIBONTO
State	:	PR
Zip	:	00705-3305
Country	:	US
Telephone Number	:	787-590-4963
Fax Number	:	787-735-2536

Authorized Official
Title or Position	:	MD
Name	:	MARIE C. LUGO
Credential	:
Telephone Number	:	787-590-4963

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/06/2022

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