Provider Demographics
NPI:1396146478
Name:NAZARIO LUGO, CAROLINE A (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:NAZARIO 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 1:998 AVE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-722-1248
Mailing Address - Fax:787-721-6098
Practice Address - Street 1:998 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-722-1248
Practice Address - Fax:787-721-6098
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18772208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice