Provider Demographics
NPI:1346066644
Name:FERNANDEZ LUGO, RONALDO
Entity type:Individual
Prefix:
First Name:RONALDO
Middle Name:
Last Name:FERNANDEZ LUGO
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 1:144 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4328
Mailing Address - Country:US
Mailing Address - Phone:786-410-9806
Mailing Address - Fax:
Practice Address - Street 1:144 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4328
Practice Address - Country:US
Practice Address - Phone:786-410-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-395350106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician