Provider Demographics
NPI:1306385471
Name:LUGO RIVERA, ERIC RAFAEL
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RAFAEL
Last Name:LUGO RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 153 KM 7.5
Mailing Address - Street 2:BO PASO SECO SECTOR USERAS
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00757
Mailing Address - Country:UM
Mailing Address - Phone:787-644-1169
Mailing Address - Fax:
Practice Address - Street 1:BO. PASO SECO SECTOR USERAS CARR 153 KM 7.5
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00757
Practice Address - Country:UM
Practice Address - Phone:787-971-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5819103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical