Provider Demographics
NPI:1346266301
Name:ROSARIO LUGO, LOURDES REBECCA (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:REBECCA
Last Name:ROSARIO LUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 N ARMENIA AVE STE B-1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5770
Mailing Address - Country:US
Mailing Address - Phone:813-352-8305
Mailing Address - Fax:
Practice Address - Street 1:931 W OAK ST STE 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4973
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-962-4446
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11298207R00000X
FLACN1104208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89013Medicare ID - Type Unspecified
49990GMedicare UPIN