MEDICARE: DR FABIO H LUGO GUTIERREZ CSP

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	261Q00000X	Clinic/Center	8442	PR

General Provider Information

NPI Number	:	1689825952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR FABIO H LUGO GUTIERREZ CSP

Provider Business Mailing Address
First Line	:	309 TORRE SAN CRISTOBAL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2856
Country	:	US
Telephone Number	:	787-842-2594
Fax Number	:	787-840-8821

Provider Business Practice Location Address
First Line	:	309 TORRE SAN CRISTOBAL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2856
Country	:	US
Telephone Number	:	787-842-2594
Fax Number	:	787-840-8821

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. YAMILET ROQUE
Credential	:
Telephone Number	:	787-842-2594

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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