Provider Demographics
NPI:1063894657
Name:MALDONADO LUGO, LINETTE
Entity type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:MALDONADO LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AVE LOS DOMINICOS
Mailing Address - Street 2:URB MIRAFLORES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-799-4116
Mailing Address - Fax:
Practice Address - Street 1:356 AVE AMERICO MIRANDA
Practice Address - Street 2:DENTAL SCHOOL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5147
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3212122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program