Provider Demographics
NPI:1285951129
Name:MINER LUGO, DENNICE A (RD)
Entity type:Individual
Prefix:MISS
First Name:DENNICE
Middle Name:A
Last Name:MINER LUGO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CALLE CLEMENCEAU
Mailing Address - Street 2:CONDOMINIO SAN RAFAEL ARCANGEL APT 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-243-6604
Mailing Address - Fax:
Practice Address - Street 1:787 CALLE HOWARD
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4027
Practice Address - Country:US
Practice Address - Phone:787-243-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered